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Warrington C, Thompson A, Read J, Abram J, Mill N, Cooper R, George K, Oxborough D. The 12-Lead Electrocardiogram of the Rugby Football League Athlete: Impact of Sex and Age. Eur J Sport Sci 2025; 25:e12304. [PMID: 40323704 PMCID: PMC12051841 DOI: 10.1002/ejsc.12304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Revised: 03/29/2025] [Accepted: 04/04/2025] [Indexed: 05/07/2025]
Abstract
Electrocardiogram (ECG) findings in male Rugby Football League (RFL) athletes have previously been investigated but variations in other demographics are less understood. The study examined 161 ECGs in male and female, paediatric (< 18 years old) and adult (≥ 18 years old) RFL athletes. Athletes (65% male, 35% female) aged 14-33 years underwent a 12-lead ECG that was assessed for training-related cardiac electrical adaptations. Four athletes with abnormal ECGs were excluded. Results indicated that male athletes had an increased PR interval (152 ± 32 vs. 140 ± 19 ms; p < 0.001), QRS duration (98 ± 7 vs. 87 ± 6 ms; p < 0.001), voltage criteria for right (6 ± 3 vs. 4 ± 2 mm; p < 0.001) and left (33 ± 9 vs. 27 ± 7 mm; p < 0.001) ventricular hypertrophy (RVH/LVH) compared to females, who exhibited increased resting heart rate (HR) (67 ± 11 vs. 62 ± 11 bpm; p < 0.001) and QTc intervals (408 ± 45 vs. 398 ± 22 ms; p = 0.028). Adult athletes had a reduced HR (61 ± 10 vs. 66 ± 13 bpm; p < 0.001) and RVH criteria (5 ± 2 vs. 7 ± 3 mm; p = 0.015) compared to paediatric athletes. When controlling for weekly training hours in adult athletes, males present only a longer PR interval (156 ± 32 vs. 141 ± 19 ms; p < 0.037) and QRS duration (99 ± 7 vs. 87 ± 7 ms; p < 0.001) when compared to females. These results highlight the need for tailored cardiac screening guidelines that account for an RFL athlete's sex, age and training exposure.
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Affiliation(s)
- Callum Warrington
- Research Institute for Sport and Exercise SciencesLiverpool John Moores UniversityLiverpoolUK
| | | | - Jade Read
- St Helens Rugby Football League ClubSt HelensUK
| | | | - Nathan Mill
- St Helens Rugby Football League ClubSt HelensUK
| | - Robert Cooper
- Research Institute for Sport and Exercise SciencesLiverpool John Moores UniversityLiverpoolUK
- Liverpool Heart and Chest HospitalLiverpoolUK
| | - Keith George
- Research Institute for Sport and Exercise SciencesLiverpool John Moores UniversityLiverpoolUK
| | - David Oxborough
- Research Institute for Sport and Exercise SciencesLiverpool John Moores UniversityLiverpoolUK
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DI Gioia G, Segreti A, Celeski M, Crispino SP, Buzzelli L, Mango F, Ferrera A, Squeo MR, Vespasiano F, Ussia GP, Grigioni F. Female athletes: a state-of-the-art review of multiorgan influence of exercise training. J Sports Med Phys Fitness 2025; 65:681-700. [PMID: 39804335 DOI: 10.23736/s0022-4707.24.16265-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2025]
Abstract
Endurance sports have witnessed an increase in female participation, demanding a constant and evolving reassessment of the specific physiological and health implications of female athletes. In the present review, we analyze cardiovascular, hematological adaptations and anthropometry and hormonal fluctuations highlighting sex-specific differences in response to exercise, with estrogen playing a fundamental role in modulating body composition and metabolic processes. Nutritional aspects, in particular energy availability, macronutrient distribution and hydration, are fundamental in supporting training demands and menstrual function. Nevertheless, the repercussions of nutritional deficiencies, interacting in the female athlete triad - which also includes amenorrhea, osteoporosis and eating disorders - underline the importance of comprehensive management strategies. In addition, we comprehensively discuss the multiorgan effects of physical training, highlighting the intersections between sex-specific differences, nutritional needs, and cardiovascular adaptations. Cardiovascular remodeling in female endurance athletes reveals both morphological and functional adaptations, requiring a deep understanding of effective cardiovascular risk assessment and screening. The synthesis of current knowledge highlights the complexity of the physiological landscape of the female athlete practicing endurance sports, requiring ongoing exploration and tailored interventions. In conclusion, this review aims to support a gender-based approach to athletic training and health management and research, intending to optimize performance while safeguarding the well-being of female athletes.
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Affiliation(s)
- Giuseppe DI Gioia
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Rome, Italy -
- Department of Movement, Human and Health Sciences, Foro Italico University of Rome, Rome, Italy -
| | - Andrea Segreti
- Department of Movement, Human and Health Sciences, Foro Italico University of Rome, Rome, Italy
- Unit of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Mihail Celeski
- Unit of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Simone P Crispino
- Unit of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Lorenzo Buzzelli
- Unit of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Federica Mango
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Rome, Italy
| | - Armando Ferrera
- Clinical and Molecular Medicine Department, Sapienza University, Rome, Italy
| | - Maria R Squeo
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Rome, Italy
| | - Francesca Vespasiano
- Unit of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Gian P Ussia
- Unit of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesco Grigioni
- Unit of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Svedberg N, Sundström J, James S, Hållmarker U, Hambraeus K, Andersen K. Long-Term Incidence of Bradycardia and Pacemaker Implantations Among Cross-Country Skiers: A Cohort Study. Circulation 2024; 150:1161-1170. [PMID: 39101218 DOI: 10.1161/circulationaha.123.068280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 07/01/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Bradycardia is more common among well-trained athletes than in the general population, but the association with pacemaker implantations is less known. We investigated associations of endurance training with incidence of bradycardia and pacemaker implantations, including sex differences and long-term outcome, in a cohort of endurance trained individuals. METHODS All Swedish skiers who completed >1 race in the cross-country skiing event Vasaloppet between 1989 and 2011 (n=209 108) and a sample of 532 290 nonskiers were followed until first event of bradycardia, pacemaker implantation, or death, depending on end point. The Swedish National Patient Register was used to obtain diagnoses. Cox regression was used to investigate associations of number of completed races and finishing time in Vasaloppet with incidence of bradycardia and pacemaker implantations. In addition, Cox regression was used to investigate associations of pacemaker implantations with death in skiers and nonskiers. RESULTS Male skiers had a higher incidence of bradycardia (adjusted hazard ratio [aHR], 1.19 [95% CI, 1.05-1.34]) and pacemaker implantations (aHR, 1.17 [95% CI, 1.04-1.31]) compared with male nonskiers. Those who completed the most races and had the best performances exhibited the highest incidence. For female skiers in Vasaloppet, the incidence of bradycardia (aHR, 0.98 [95% CI, 0.75-1.30]) and pacemaker implantations (aHR, 0.98 [95% CI, 0.75-1.29]) was not different from that of female nonskiers. The indication for pacemaker differed between skiers and nonskiers, with sick sinus syndrome more common in the former and third-degree atrioventricular block in the latter. Skiers had lower overall mortality rates than nonskiers (aHR, 0.16 [95% CI, 0.15-0.17]). There were no differences in mortality rates by pacemaker status among skiers. CONCLUSIONS In this study, male endurance skiers had a higher incidence of bradycardia and pacemaker implantations compared with nonskiers, a pattern not seen in women. Among male skiers, those who completed the most races and had the fastest finishing times had the highest incidence of bradycardia and pacemaker implantations. Within each group, mortality rates did not differ in relation to pacemaker status. These findings suggest that bradycardia associated with training leads to a higher risk for pacemaker implantation without a detrimental effect on mortality risk.
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Affiliation(s)
- Niclas Svedberg
- Department of Medical Sciences, Uppsala University, Sweden (N.S., J.S., S.J., U.H., K.H., K.A.)
- Department of Cardiology, Falun Hospital, Sweden (N.S., K.H.)
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Sweden (N.S., J.S., S.J., U.H., K.H., K.A.)
| | - Stefan James
- Department of Medical Sciences, Uppsala University, Sweden (N.S., J.S., S.J., U.H., K.H., K.A.)
| | - Ulf Hållmarker
- Department of Medical Sciences, Uppsala University, Sweden (N.S., J.S., S.J., U.H., K.H., K.A.)
- Department of Internal Medicine, Mora Hospital, Sweden (U.H.)
| | - Kristina Hambraeus
- Department of Medical Sciences, Uppsala University, Sweden (N.S., J.S., S.J., U.H., K.H., K.A.)
- Department of Cardiology, Falun Hospital, Sweden (N.S., K.H.)
| | - Kasper Andersen
- Department of Medical Sciences, Uppsala University, Sweden (N.S., J.S., S.J., U.H., K.H., K.A.)
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Lasocka-Koriat Z, Lewicka-Potocka Z, Kaleta-Duss A, Siekierzycka A, Kalinowski L, Lewicka E, Dąbrowska-Kugacka A. Differences in cardiac adaptation to exercise in male and female athletes assessed by noninvasive techniques: a state-of-the-art review. Am J Physiol Heart Circ Physiol 2024; 326:H1065-H1079. [PMID: 38391314 PMCID: PMC11380999 DOI: 10.1152/ajpheart.00756.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 02/24/2024]
Abstract
Athlete's heart is generally regarded as a physiological adaptation to regular training, with specific morphological and functional alterations in the cardiovascular system. Development of the noninvasive imaging techniques over the past several years enabled better assessment of cardiac remodeling in athletes, which may eventually mimic certain pathological conditions with the potential for sudden cardiac death, or disease progression. The current literature provides a compelling overview of the available methods that target the interrelation of prolonged exercise with cardiac structure and function. However, this data stems from scientific studies that included mostly male athletes. Despite the growing participation of females in competitive sport meetings, little is known about the long-term cardiac effects of repetitive training in this population. There are several factors-biochemical, physiological and psychological, that determine sex-dependent cardiac response. Herein, the aim of this review was to compare cardiac adaptation to endurance exercise in male and female athletes with the use of electrocardiographic, echocardiographic, and biochemical examination, to determine the sex-specific phenotypes, and to improve the healthcare providers' awareness of cardiac remodeling in athletes. Finally, we discuss the possible exercise-induced alternations that should arouse suspicion of pathology and be further evaluated.
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Affiliation(s)
- Zofia Lasocka-Koriat
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Kaleta-Duss
- Institute for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Anna Siekierzycka
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
- BioTechMed Centre/Department of Mechanics of Materials and Structures, Gdańsk University of Technology, Gdańsk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
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Ahmadi P, Afzalian A, Jalali A, Sadeghian S, Masoudkabir F, Oraii A, Ayati A, Nayebirad S, Pezeshki PS, Lotfi Tokaldani M, Shafiee A, Mohammadi M, Sanei E, Tajdini M, Hosseini K. Age and gender differences of basic electrocardiographic values and abnormalities in the general adult population; Tehran Cohort Study. BMC Cardiovasc Disord 2023; 23:303. [PMID: 37328821 PMCID: PMC10273511 DOI: 10.1186/s12872-023-03339-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/09/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Although several studies are available regarding baseline Electrocardiographic (ECG) parameters and major and minor ECG abnormalities, there is considerable controversy regarding their age and gender differences in the literature. METHODS Data from 7630 adults aged ≥ 35 from the Tehran Cohort Study registered between March 2016 and March 2019 were collected. Basic ECG parameters values and abnormalities related to arrhythmia, defined according to the American Heart Association definitions, were analyzed and compared between genders and four distinct age groups. The odds ratio of having any major ECG abnormality between men and women, stratified by age, was calculated. RESULTS The average age was 53.6 (± 12.66), and women made up 54.2% (n = 4132) of subjects. The average heart rate (HR) was higher among women(p < 0.0001), while the average values of QRS duration, P wave duration, and RR intervals were higher among men(p < 0.0001). Major ECG abnormalities were observed in 2.9% of the study population (right bundle branch block, left bundle branch block, and Atrial Fibrillation were the most common) and were more prevalent among men compared to women but without statistical significance (3.1% vs. 2.7% p = 0.188). Moreover, minor abnormalities were observed in 25.9% of the study population and again were more prevalent among men (36.4% vs. 17% p < 0.001). The prevalence of major ECG abnormalities was significantly higher in participants older than 65. CONCLUSION Major and minor ECG abnormalities were roughly more prevalent in male subjects. In both genders, the odds of having major ECG abnormalities surge with an increase in age.
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Affiliation(s)
- Pooria Ahmadi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arian Afzalian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Sadeghian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Oraii
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Aryan Ayati
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepehr Nayebirad
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parmida Sadat Pezeshki
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Lotfi Tokaldani
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiee
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mohammadi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Sanei
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masih Tajdini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Romero-Perales E, Sainz-de-Baranda Andujar C, López-Ongil C. Electronic Design for Wearables Devices Addressed from a Gender Perspective: Cross-Influences and a Methodological Proposal. SENSORS (BASEL, SWITZERLAND) 2023; 23:5483. [PMID: 37420649 DOI: 10.3390/s23125483] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 07/09/2023]
Abstract
The design of wearable devices has been approached from many perspectives over the years, mainly from a functionality, electronics, mechanics, usability, wearability, or product design perspective. However, there is a missing point in these approaches: the gender perspective. Gender intersects with every approach and, considering the interrelationships and dependencies, can achieve a better adherence, reach a wider audience, and even change the conception of the wearables design paradigm. The electronics design addressed from a gender perspective must consider both the morphological and anatomical impacts and those emanating from socialization. This paper presents an analysis of the different factors to consider when designing the electronics of a wearable device, including the functionality to implement, sensors, communications, or the location, together with their interdependencies, and proposes a user-centered methodology that contemplates a gender perspective at every stage. Finally, we present a use case that validates the proposed methodology in a real design of a wearable device for the prevention of gender-based violence cases. For the application of the methodology, 59 experts have been interviewed, 300 verbatims have been extracted and analyzed, a dataset from the data of 100 women has been created and the wearable devices have been tested for a week by 15 users. The electronics design needs to be addressed from a multidisciplinary approach, by rethinking the decisions taken for granted and analyzing the implications and interrelationships from a gender perspective. We need to enroll more diverse people at every design stage and include gender as one of the variables to study.
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Affiliation(s)
- Elena Romero-Perales
- Departamento de Tecnología Electrónica, Universidad Carlos III Madrid, 28911 Leganés, Spain
- Instituto de Estudios de Género, Universidad Carlos III Madrid, 28903 Getafe, Spain
| | - Clara Sainz-de-Baranda Andujar
- Instituto de Estudios de Género, Universidad Carlos III Madrid, 28903 Getafe, Spain
- Departamento de Comunicación, Universidad Carlos III Madrid, 28903 Getafe, Spain
| | - Celia López-Ongil
- Departamento de Tecnología Electrónica, Universidad Carlos III Madrid, 28911 Leganés, Spain
- Instituto de Estudios de Género, Universidad Carlos III Madrid, 28903 Getafe, Spain
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van der Bijl K, Elgendi M, Menon C. Automatic ECG Quality Assessment Techniques: A Systematic Review. Diagnostics (Basel) 2022; 12:2578. [PMID: 36359421 PMCID: PMC9689601 DOI: 10.3390/diagnostics12112578] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/25/2023] Open
Abstract
Cardiovascular diseases are the leading cause of death, globally. Stroke and heart attacks account for more than 80% of cardiovascular disease-related deaths. To prevent patient mismanagement and potentially save lives, effective screening at an early stage is needed. Diagnosis is typically made using an electrocardiogram (ECG) analysis. However, ECG recordings are often corrupted by different types of noise, degrading the quality of the recording and making diagnosis more difficult. This paper reviews research on automatic ECG quality assessment techniques used in studies published from 2012-2022. The CinC11 Dataset is most often used for training and testing algorithms. Only one study tested its algorithm on people in real-time, but it did not specify the demographic data of the subjects. Most of the reviewed papers evaluated the quality of the ECG recordings per single lead. The accuracy of the algorithms reviewed in this paper range from 85.75% to 97.15%. More clarity on the research methods used is needed to improve the quality of automatic ECG quality assessment techniques and implement them in a clinical setting. This paper discusses the possible shortcomings in current research and provides recommendations on how to advance the field of automatic ECG quality assessment.
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Subtypes and Mechanisms of Hypertrophic Cardiomyopathy Proposed by Machine Learning Algorithms. LIFE (BASEL, SWITZERLAND) 2022; 12:life12101566. [PMID: 36294999 PMCID: PMC9605444 DOI: 10.3390/life12101566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a relatively common inherited cardiac disease that results in left ventricular hypertrophy. Machine learning uses algorithms to study patterns in data and develop models able to make predictions. The aim of this study is to identify HCM subtypes and examine the mechanisms of HCM using machine learning algorithms. Clinical and laboratory findings of 143 adult patients with a confirmed diagnosis of nonobstructive HCM are analyzed; HCM subtypes are determined by clustering, while the presence of different HCM features is predicted in classification machine learning tasks. Four clusters are determined as the optimal number of clusters for this dataset. Models that can predict the presence of particular HCM features from other genotypic and phenotypic information are generated, and subsets of features sufficient to predict the presence of other features of HCM are determined. This research proposes four subtypes of HCM assessed by machine learning algorithms and based on the overall phenotypic expression of the participants of the study. The identified subsets of features sufficient to determine the presence of particular HCM aspects could provide deeper insights into the mechanisms of HCM.
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Abstract
Eating disorders can have serious consequences for adolescent patients. Early detection and coordination of treatment can improve outcomes. The coronavirus disease 2019 pandemic has negatively affected mental health, and eating disorders are no exception. The reported increase in eating disorder behaviors and referrals for treatment, combined with the shortage of treatment options, has underscored the role of the outpatient pediatrician. Detection of eating disorders in the primary care setting starts with analyzing vitals and weight trends. If suspecting an eating disorder, one should complete a thorough history with pertinent review of systems, physical examination, and an initial laboratory evaluation. Upon confirming a diagnosis, it is important for a pediatrician to decide on the level of care needed. Given long wait times for treatment centers, utilization of local resources is helpful for coordinating a multidisciplinary approach. Increased funding for eating disorder treatment initiatives could help alleviate the current strain on our health care system. [Pediatr Ann. 2022;51(4):e150-e153.].
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Differences in American Athletes Undergoing Preparticipation Examination by Sex, Participation Level, and Age. Clin J Sport Med 2021; 31:e432-e441. [PMID: 32073474 DOI: 10.1097/jsm.0000000000000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 08/17/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the preparticipation examination findings among American athletes by sex, participation level, and age. DESIGN Hypothesis-generating retrospective cohort study. SETTING Saint-Luke's Athletic Heart Center, Kansas City, Missouri. PARTICIPANTS A total of 2954 student athletes. INTERVENTIONS Athletes underwent preparticipation examination, which included history and physical, electrocardiogram, and 2-D transthoracic echocardiogram. MAIN OUTCOME MEASURES Differences noted on screening preparticipation examination by sex, participation level, and age. RESULTS Female athletes reported more symptoms than male athletes (odds ratio [OR] = 1.61; 95% confidence interval [CI], 1.32-1.97; P < 0.0001) but had lower prevalence of abnormal electrocardiogram (OR 0.52; CI, 0.39-0.68; P < 0.0001). College athletes reported fewer symptoms than novice athletes (OR 0.35; CI, 0.29-0.43; P < 0.0001) with no difference in the prevalence of abnormal electrocardiography (ECG) (OR 0.96; CI, 0.73-1.26; P = 0.78). Older athletes reported fewer symptoms than younger athletes (OR 0.61; CI, 0.52-0.71; P < 0.0001) with no difference in the prevalence of abnormal ECG (OR 1.00; CI, 0.81-1.23; P = 0.89). There were 43 athletes with clinically important findings with no difference in prevalence of these findings across sex, participation level, and age. CONCLUSIONS Among this American cohort of athletes, male athletes reported fewer symptoms and had higher prevalence of abnormal ECG findings compared with female athletes. College and older athletes reported fewer symptoms and had no difference in prevalence of abnormal ECG findings compared with novice and younger athletes, respectively. Despite these differences between groups, the prevalence of clinically important findings was comparable among groups.
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11
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A comprehensive electrocardiographic analysis for young athletes. Med Biol Eng Comput 2021; 59:1865-1876. [PMID: 34342819 DOI: 10.1007/s11517-021-02401-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
ECG-based differences between athletes and sedentary adolescents are a frequently investigated subject in sports medicine. Especially, training-induced ECG variations are common in adult athletes and sustained training often leads to anatomical changes in the heart that can yield abnormalities in ECG. Therefore, ECG screening in athletes is important in diagnosis of cardiac problems of young athletes. The present work investigated the ECG characteristics of young athletes in terms of both gender and sedentary healthy young control group differences. Besides comparison between groups, analysis parameters were also investigated within the groups using correlation analysis. ECG characteristics were extracted using wavelet transform-based adaptive algorithms. Results showed that ECGs of athletes demonstrate differences related to gender and compared to young sedentary. Athletes had significantly lower heart rate; higher QTc, P, and T amplitudes; ST segment; and ST, QT, and RR intervals compared to control group (p < 0.05). Proposed new parameter, namely "scalogram" of each wave, was lower in male athletes compared to other groups (p < 0.05). Negative correlation between T wave amplitude and RR interval could be an indicator of long QT syndrome for male athletes. Furthermore, prolongation of QRS interval in athletes could be the underlying reason of changes in T wave amplitude. Findings of this study can propose indicators for understanding the possible diseases as well as help evaluate the sudden changes in athlete's heart.
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Lasocka Z, Dąbrowska-Kugacka A, Kaleta AM, Lewicka-Potocka Z, Faran A, Szołkiewicz E, Przybyłowski K, Szołkiewicz A, Daniluk P, Raczak G, Lewicka E. Electrocardiographic Changes in Male and Female Amateur Marathon Runners: A Comparison Study. Int J Sports Med 2021; 42:936-944. [PMID: 33621993 DOI: 10.1055/a-1323-3215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Physical training is gaining popularity among amateurs. Males and females exhibit different cardiac adaptation to exercise. The aim of the study was to compare the incidence of electrocardiographic abnormalities before and after the marathon between sexes. 12-lead electrocardiogram was performed in 40 male (39±8 years) and 27 female (40±7 years) amateur runners: 2-3 weeks before (Stage 1) and immediately after (Stage 2) the marathon. Abnormalities in the resting (Stage 1) and exercise (Stage 2) electrocardiograms were compared between sexes. At rest left atrial enlargement was more frequent in females than males (48 vs. 20%; p<0.05). The incidence of right atrial enlargement was significantly more common at Stage 2 than 1, both in men (43 vs. 0%; p<0.001) and in women (48 vs. 4%; p=0.001). Significant increase of P-wave amplitude was found in male runners after the marathon (0.12±0.05 vs. 0.21±0.09 mV; p<0.001 Stage 1 vs. 2), but was absent in females. QTc prolongation was observed in both sexes, however to a higher degree in males (p<0.05 for the interaction stage and sex). Although both male and female amateur marathon runners exhibit abnormalities in resting and exercise electrocardiograms, men present more exercise-induced electrocardiographic changes, which might indicate a higher propensity for post-marathon arrhythmias. Electrocardiographic screening in amateurs should be considered.
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Affiliation(s)
- Zofia Lasocka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | | | - Anna Maria Kaleta
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Anna Faran
- University Clinical Centre in Gdańsk, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Szołkiewicz
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Krystian Przybyłowski
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Alicja Szołkiewicz
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Paulina Daniluk
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
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13
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Grouthier V, Moey MYY, Gandjbakhch E, Waintraub X, Funck-Brentano C, Bachelot A, Salem JE. Sexual Dimorphisms, Anti-Hormonal Therapy and Cardiac Arrhythmias. Int J Mol Sci 2021; 22:ijms22031464. [PMID: 33540539 PMCID: PMC7867204 DOI: 10.3390/ijms22031464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 02/07/2023] Open
Abstract
Significant variations from the normal QT interval range of 350 to 450 milliseconds (ms) in men and 360 to 460 ms in women increase the risk for ventricular arrhythmias. This difference in the QT interval between men and women has led to the understanding of the influence of sex hormones on the role of gender-specific channelopathies and development of ventricular arrhythmias. The QT interval, which represents the duration of ventricular repolarization of the heart, can be affected by androgen levels, resulting in a sex-specific predilection for acquired and inherited channelopathies such as acquired long QT syndrome in women and Brugada syndrome and early repolarization syndrome in men. Manipulation of the homeostasis of these sex hormones as either hormonal therapy for certain cancers, recreational therapy or family planning and in transgender treatment has also been shown to affect QT interval duration and increase the risk for ventricular arrhythmias. In this review, we highlight the effects of endogenous and exogenous sex hormones in the physiological and pathological states on QTc variation and predisposition to gender-specific pro-arrhythmias.
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Affiliation(s)
- Virginie Grouthier
- Department of Endocrinology, Diabetes and Nutrition, Centre Hospitalier Universitaire de Bordeaux, Haut Leveque Hospital, F-33000 Bordeaux, France;
| | - Melissa Y. Y. Moey
- Department of Cardiovascular Disease, Vidant Medical Center/East Carolina University, Greenville, NC 27834, USA;
| | - Estelle Gandjbakhch
- APHP, Pitié-Salpêtrière Hospital, Institute of Cardiology, Centre de Référence des Maladies Cardiaques Héréditaires, Institute of Cardiometabolism and Nutrition (ICAN), UPMC Univ Paris 06, INSERM 1166, Sorbonne Universités, F-75013 Paris, France; (E.G.); (X.W.)
| | - Xavier Waintraub
- APHP, Pitié-Salpêtrière Hospital, Institute of Cardiology, Centre de Référence des Maladies Cardiaques Héréditaires, Institute of Cardiometabolism and Nutrition (ICAN), UPMC Univ Paris 06, INSERM 1166, Sorbonne Universités, F-75013 Paris, France; (E.G.); (X.W.)
| | - Christian Funck-Brentano
- INSERM, CIC-1901, AP-HP, Pitié-Salpêtrière Hospital, Regional Pharmacovigilance Center, UNICO-GRECO Cardio-Oncology Program, Department of Pharmacology and Clinical Investigation Center, CLIP2 Galilée, Sorbonne Université, F-75013 Paris, France;
| | - Anne Bachelot
- AP-HP, Pitié-Salpêtrière Hospital, IE3M, and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, and Centre de Référence des Pathologies Gynécologiques Rares, Department of Endocrinology and Reproductive Medicine, Sorbonne Université, F-75013 Paris, France;
| | - Joe-Elie Salem
- INSERM, CIC-1901, AP-HP, Pitié-Salpêtrière Hospital, Regional Pharmacovigilance Center, UNICO-GRECO Cardio-Oncology Program, Department of Pharmacology and Clinical Investigation Center, CLIP2 Galilée, Sorbonne Université, F-75013 Paris, France;
- Cardio-Oncology Program, Department of Medicine and Pharmacology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Correspondence: ; Tel.: +33-1-42-17-85-31 or +1-(615)-322-0067
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14
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Rambarat CA, Reifsteck F, Clugston JR, Handberg EM, Martinez MW, Hamburger R, Street JM, Asken B, Taha Y, Kelling M, Dimza M, Dasa O, Pepine CJ, Edenfield KM. Preparticipation Cardiac Evaluation Findings in a Cohort of Collegiate Female Athletes. Am J Cardiol 2021; 140:134-139. [PMID: 33144161 DOI: 10.1016/j.amjcard.2020.10.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/24/2022]
Abstract
Knowledge of cardiovascular adaptations in athletes has predominantly focused on males, with limited data available on females who compromise a substantial percentage of all collegiate athletes. A multicenter retrospective cohort review of preparticipation cardiovascular screening data of 329 National Collegiate Athletic Association Division I female athletes was performed. This included physical exams, electrocardiograms, and echocardiograms. Female athletes in class IB sports had elevated systolic blood pressure (p = 0.01). For electrocardiograms, 7 (2%) had abnormal findings: 100% were white; 6 of 7 (86%) participated in IIC sports. Black athletes had longer PR intervals (p ≤ 0.001), whereas white athletes had longer QTc and QRS durations (p = 0.02 and 0.01, respectively). Athletes in IC and IIC sports had longer QTc intervals (p = 0.01). For echocardiographic parameters, no differences were noted based on race. However, significant differences were noted based on classification of sport: athletes in class IC sports had higher left-atrial volume indexes and E/A ratios. Athletes in class IB and IIC had increased left-ventricular wall thicknesses and aortic root dimensions. In conclusion, among one of the largest cohorts of collegiate female athlete preparticipation cardiac screening data to date, significant differences in various parameters based on classification of sport and race were observed. These categorizations should be considered when interpreting cardiovascular screening in female collegiate athletes to improve screening and guide future research.
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15
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Hornberger LL, Lane MA. Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics 2021; 147:peds.2020-040279. [PMID: 33386343 DOI: 10.1542/peds.2020-040279] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Eating disorders are serious, potentially life-threatening illnesses afflicting individuals through the life span, with a particular impact on both the physical and psychological development of children and adolescents. Because care for children and adolescents with eating disorders can be complex and resources for the treatment of eating disorders are often limited, pediatricians may be called on to not only provide medical supervision for their patients with diagnosed eating disorders but also coordinate care and advocate for appropriate services. This clinical report includes a review of common eating disorders diagnosed in children and adolescents, outlines the medical evaluation of patients suspected of having an eating disorder, presents an overview of treatment strategies, and highlights opportunities for advocacy.
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Affiliation(s)
- Laurie L Hornberger
- Division of Adolescent Medicine, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - Margo A Lane
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
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16
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Sessa F, Anna V, Messina G, Cibelli G, Monda V, Marsala G, Ruberto M, Biondi A, Cascio O, Bertozzi G, Pisanelli D, Maglietta F, Messina A, Mollica MP, Salerno M. Heart rate variability as predictive factor for sudden cardiac death. Aging (Albany NY) 2018; 10:166-177. [PMID: 29476045 PMCID: PMC5842851 DOI: 10.18632/aging.101386] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/09/2018] [Indexed: 02/01/2023]
Abstract
Sudden cardiac death (SCD) represents about 25% of deaths in clinical cardiology. The identification of risk factors for SCD is the philosopher's stone of cardiology and the identification of non-invasive markers of risk of SCD remains one of the most important goals for the scientific community.The aim of this review is to analyze the state of the art around the heart rate variability (HRV) as a predictor factor for SCD.HRV is probably the most analyzed index in cardiovascular risk stratification technical literature, therefore an important number of models and methods have been developed.Nowadays, low HRV has been shown to be independently predictive of increased mortality in post- myocardial infarction patients, heart failure patients, in contrast with the data of the general population.Contrariwise, the relationship between HRV and SCD has received scarce attention in low-risk cohorts. Furthermore, in general population the attributable risk is modest and the cost/benefit ratio is not always convenient.The HRV evaluation could become an important tool for health status in risks population, even though the use of HRV alone for risk stratification of SCD is limited and further studies are needed.
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Affiliation(s)
- Francesco Sessa
- University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy
- Equal contribution
| | - Valenzano Anna
- University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy
- Equal contribution
| | - Giovanni Messina
- University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy
| | - Giuseppe Cibelli
- University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy
| | - Vincenzo Monda
- Università degli Studi di Napoli Federico II, Department of Experimental Medicine, Naples, Italy
| | - Gabriella Marsala
- Struttura Complessa di Farmacia, Azienda Ospedaliero-Universitaria, Foggia, Italy
| | - Maria Ruberto
- CRD Center, Santa Maria del Pozzo, Somma Vesuviana (NA), Italy
| | - Antonio Biondi
- University of Catania, Department of Surgery, Catania, Italy
| | - Orazio Cascio
- University of Catania, Department of Anatomy, Catania, Italy
| | - Giuseppe Bertozzi
- University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy
| | - Daniela Pisanelli
- University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy
| | - Francesca Maglietta
- University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy
| | - Antonietta Messina
- Università degli Studi di Napoli Federico II, Department of Experimental Medicine, Naples, Italy
| | - Maria P. Mollica
- Università degli Studi di Napoli Federico II, Department of Experimental Medicine, Naples, Italy
| | - Monica Salerno
- University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy
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18
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Effect of age and gender on the QTc-interval in healthy individuals and patients with long-QT syndrome. Trends Cardiovasc Med 2017; 28:64-75. [PMID: 28869094 DOI: 10.1016/j.tcm.2017.07.012] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 12/15/2022]
Abstract
Age- and gender-related differences in QTc-interval are most likely the result of changes in sex-specific hormones. Although the exact mechanisms and pathophysiology of sex hormones on the QTc-interval are not known, testosterone appears to shorten the QTc-interval. In females, however, there is a more complex interaction between progesterone and estrogen. In patients with an impaired repolarization, such as long-QT syndrome (LQTS), the effect of these sex hormones on the QTc-interval is more pronounced with a differing sensitivity between the LQTS genotypes.
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