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Conte E, Pizzamiglio F, Dessanai MA, Guarnieri G, Ardizzone V, Schillaci M, Dello Russo A, Casella M, Mushtaq S, Melotti E, Marchetti D, Volpato V, Drago G, Gigante C, Sforza C, Bartorelli AL, Pepi M, Pontone G, Tondo C, Andreini D. Prevalence and prognosis of structural heart disease among athletes with negative T waves and normal transthoracic echocardiography. Clin Res Cardiol 2024; 113:706-715. [PMID: 37582977 DOI: 10.1007/s00392-023-02282-5] [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: 04/08/2023] [Accepted: 07/31/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION The aim of the present study was to evaluate the prevalence and prognosis of structural heart disease (SHD) among competitive athletes with negative T waves without pathological findings at transthoracic echocardiogram. METHODS From a prospective register of 450 athletes consecutively evaluated during a second-level cardiological examination, we retrospectively identified all subjects with the following inclusion criteria: (1) not previously known cardiovascular disease; (2) negative T waves in leads other than V1-V2; (3) normal transthoracic echocardiogram. Patients underwent cardiac MRI and CT. The primary endpoint was the diagnosis of definite SHD after multimodality imaging evaluation. A follow-up was collected for a combined end-point of sudden death, resuscitated sudden cardiac death and hospitalization for any cardiovascular causes. RESULTS A total of 55 competitive athletes were finally enrolled (50 males, 90%) with a mean age of 27.5 ± 14.1 years. Among the population enrolled 16 (29.1%) athletes had a final diagnosis of SHD. At multivariate analysis, only deep negative T waves remained statistically significant [OR (95% CI) 7.81 (1.24-49.08), p = 0.0285]. Contemporary identification of deep negative T waves and complex arrhythmias in the same patients appeared to have an incremental diagnostic value. No events were collected at 49.3 ± 12.3 months of follow-up. CONCLUSIONS In a cohort of athletes with negative T waves at ECG, cardiac MRI (and selected use of cardiac CT) enabled the identification of 16 (29.1%) subjects with SHD despite normal transthoracic echocardiography. Deep negative T waves and complex ventricular arrhythmias were the only clinical characteristic associated with SHD diagnosis.
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Affiliation(s)
- Edoardo Conte
- Centro Cardiologico Monzino IRCCS, Milan, Italy.
- Department of Biomedical Science for Health, University of Milan, Milan, Italy.
| | | | | | | | | | | | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti" Ancona, Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti" Ancona, Ancona, Italy
| | | | | | | | | | | | | | - Chiarella Sforza
- Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | | | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Claudio Tondo
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Mert KU, İlgüy S, Mert GÖ, Dural M, Iskenderov K. Noninvasive predictors of cardiac arrhythmias in bodybuilders. Rev Port Cardiol 2018; 37:693-701. [DOI: 10.1016/j.repc.2018.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 11/04/2017] [Accepted: 01/10/2018] [Indexed: 10/28/2022] Open
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3
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Mert KU, İlgüy S, Mert GÖ, Dural M, Iskenderov K. Noninvasive predictors of cardiac arrhythmias in bodybuilders. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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4
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Not All Electrocardiographic Variants in Black Patients Can be Considered "Normal". Am J Cardiol 2018; 121:1012-1013. [PMID: 29472005 DOI: 10.1016/j.amjcard.2018.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 01/02/2018] [Indexed: 11/23/2022]
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Lazarevic Z, Ciminelli E, Quaranta F, Sperandii F, Guerra E, Pigozzi F, Borrione P. Left ventricular false tendons and electrocardiogram repolarization abnormalities in healthy young subjects. World J Cardiol 2016; 8:590-595. [PMID: 27847560 PMCID: PMC5088365 DOI: 10.4330/wjc.v8.i10.590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/26/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To describe echocardiographically left ventricular false tendon characteristics and the correlation with ventricular repolarization abnormalities in young athletes.
METHODS Three hundred and sixteen healthy young athletes from different sport disciplines were evaluated from 2009 to 2011 during routine screening for agonistic sports eligibility. All subjects, as part of standard pre-participation screening medical evaluation, underwent a basal and post step test 12-lead electrocardiogram (ECG). The athletes with abnormal T-wave flattening and/or inversion were considered for an echocardiogram evaluation and an incremental maximal exercise test on a cycle ergometer. Arterial blood pressure and heart rate, during and after exercise, were also measured.
RESULTS Twenty-one of the 316 subjects (6.9%) showed false tendons in the left ventricle. The majority of false tendons (52.38%) were localized between the middle segments of the inferior septum and the lateral wall, 19.06% between the distal segments of the septum and the lateral wall, in 5 subjects between the middle segments of the anterior and inferior walls, and in one subject between the middle segments of the anterior septum and the posterior wall. ECG abnormalities, represented by alterations of ventricular repolarization, were found in 11 subjects (52.38%), 90% of these anomalies were T wave abnormalities from V1 to V3. These anomalies disappeared with an increasing heart rate following the three minute step test as well as during the execution of the maximal exercise.
CONCLUSION Left ventricular false tendons are frequently localized between the middle segments of the inferior septum and the lateral wall and are statistically associated with ventricular repolarization abnormalities.
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D'Ascenzi F, Zorzi A, Alvino F, Bonifazi M, Corrado D, Mondillo S. The prevalence and clinical significance of premature ventricular beats in the athlete. Scand J Med Sci Sports 2016; 27:140-151. [DOI: 10.1111/sms.12679] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2016] [Indexed: 11/30/2022]
Affiliation(s)
- F. D'Ascenzi
- Department of Medical Biotechnologies; Division of Cardiology; University of Siena; Siena Italy
| | - A. Zorzi
- Department of Cardiac, Thoracic, and Vascular Sciences; University of Padova; Padova Italy
| | - F. Alvino
- Department of Medical Biotechnologies; Division of Cardiology; University of Siena; Siena Italy
| | - M. Bonifazi
- Department of Medicine, Surgery, and NeuroScience; University of Siena; Siena Italy
| | - D. Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences; University of Padova; Padova Italy
| | - S. Mondillo
- Department of Medical Biotechnologies; Division of Cardiology; University of Siena; Siena Italy
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Birnbaum Y, Nikus K, Kligfield P, Fiol M, Barrabés JA, Sionis A, Pahlm O, Niebla JG, de Luna AB. The role of the ECG in diagnosis, risk estimation, and catheterization laboratory activation in patients with acute coronary syndromes: a consensus document. Ann Noninvasive Electrocardiol 2015; 19:412-25. [PMID: 25262661 DOI: 10.1111/anec.12196] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The electrocardiogram (ECG) is the most widely used imaging tool helping in diagnosis and initial management of patients presenting with symptoms compatible with acute coronary syndrome. Acute ischemia affects the configuration of the QRS complexes, the ST segments and the T waves. The ECG should be read along with the clinical assessment of the patient. ST segment elevation (and ST depression in leads V1 -V3 ) in patients with active symptoms usually indicates acute occlusion of an epicardial artery with ongoing transmural ischemia. These patients should be triaged for emergent reperfusion therapy per current guidelines. However, many patients have ST segment elevation secondary to nonischemic causes. ST depression in leads other than V1 -V3 usually are indicative of subendocardial ischemia secondary to subocclusion of the epicardial artery, distal embolization to small arteries or spasm supply/demand mismatch. ST depression may also be secondary to nonischemic etiologies, such as left ventricular hypertrophy, cardiomyopathies, etc. Knowing the clinical scenario, comparison to previous ECG and subsequent ECGs (in cases that there are changes in the quality or severity of symptoms) may add in the diagnosis and interpretation in difficult cases. This review addresses the different ECG patterns, typically seen in patients with active symptoms, after resolution of symptoms and the significance of such changes when seen in asymptomatic patients.
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Affiliation(s)
- Yochai Birnbaum
- The Section of Cardiology, The Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Mitchell ARJ, Hurry R, Le Page P, MacLachlan H. Pre-participation cardiovascular screening: is community screening using hand-held cardiac ultrasound feasible? Echo Res Pract 2015; 2:49-55. [PMID: 26693333 PMCID: PMC4676452 DOI: 10.1530/erp-15-0010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 04/03/2015] [Accepted: 04/15/2015] [Indexed: 11/16/2022] Open
Abstract
We evaluated the feasibility and costs of utilising hand-held cardiac ultrasound (HHCU) as part of a community-based pre-participation cardiovascular screening programme. Ninety-seven school children were screened using a personal history, a physical examination, a resting 12-lead electrocardiogram (ECG) and a HHCU. A consultant cardiologist independently reviewed and reported the data. Previously undiagnosed cardiovascular abnormalities were identified in nine participants (9%). An additional three participants (3%) were diagnosed with hypertension. The nine abnormalities were identified at a cost of £460 per finding, with a cost of £43 per participant screened. The marginal cost of adding a HHCU to the personal history, physical examination and ECG was £16 per participant. Pre-participation screening in the community using hand-held echocardiography is practical and inexpensive. The additional sensitivity and specificity provided by the ultrasound may enhance screening programmes, thereby reducing false positives and the need for expensive follow-up testing.
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Affiliation(s)
- A R J Mitchell
- Department of Cardiology, Jersey International Centre for Advanced Studies, Jersey General Hospital, Gloucester Street, St Helier, JE1 3QS, Channel Islands, Jersey
| | - R Hurry
- Department of Cardiology, Jersey International Centre for Advanced Studies, Jersey General Hospital, Gloucester Street, St Helier, JE1 3QS, Channel Islands, Jersey
| | - P Le Page
- Department of Cardiology, Jersey International Centre for Advanced Studies, Jersey General Hospital, Gloucester Street, St Helier, JE1 3QS, Channel Islands, Jersey
| | - H MacLachlan
- Department of Cardiology, Jersey International Centre for Advanced Studies, Jersey General Hospital, Gloucester Street, St Helier, JE1 3QS, Channel Islands, Jersey
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9
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Jacob D, Main ML, Gupta S, Gosch K, McCoy M, Magalski A. Prevalence and significance of isolated T wave inversion in 1755 consecutive American collegiate athletes. J Electrocardiol 2015; 48:407-14. [PMID: 25795567 DOI: 10.1016/j.jelectrocard.2015.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND We evaluated the prevalence of isolated T-wave inversions (TWI) in American athletes using contemporary ECG criteria. Ethnic and gender disparities including the association of isolated TWI with underlying abnormal cardiac structure are evaluated. METHODS From 2004 to 2014, 1755 collegiate athletes at a single American university underwent prospective collection of medical history, physical examination, 12-lead ECG, and 2-dimensional echocardiography. ECG analysis was performed to evaluate for isolated TWI as per contemporary ECG criteria. RESULTS The overall prevalence of isolated TWI is 1.3%. Ethnic and gender disparities are not observed in American athletes (black vs. white: 1.7% vs. 1.1%; p=0.41) (women vs. men: 1.5% vs. 1.1; p=0.52). No association was found with underlying cardiomyopathy. CONCLUSION A lower prevalence of isolated TWI in American athletes than previously reported. Isolated TWI was not associated with an abnormal echocardiogram. No ethnic or gender disparity is seen in American college athletes.
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Affiliation(s)
- Dany Jacob
- University of Missouri-Kansas City, 2301 Holmes St, Kansas City, MO, USA
| | - Michael L Main
- Saint Luke's Mid America Heart Institute, 4401 Wornwall Rd, Kansas City, MO, USA
| | - Sanjaya Gupta
- Saint Luke's Mid America Heart Institute, 4401 Wornwall Rd, Kansas City, MO, USA
| | - Kensey Gosch
- Saint Luke's Mid America Heart Institute, 4401 Wornwall Rd, Kansas City, MO, USA
| | - Marcia McCoy
- Saint Luke's Mid America Heart Institute, 4401 Wornwall Rd, Kansas City, MO, USA
| | - Anthony Magalski
- Saint Luke's Mid America Heart Institute, 4401 Wornwall Rd, Kansas City, MO, USA.
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Tischer SG, Mattsson N, Storgaard M, Høfsten DE, Høst NB, Andersen LJ, Prescott E, Rasmusen HK. Results of voluntary cardiovascular examination of elite athletes in Denmark: Proposal for Nordic collaboration. Scand J Med Sci Sports 2015; 26:64-73. [DOI: 10.1111/sms.12405] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2014] [Indexed: 01/17/2023]
Affiliation(s)
- S. G. Tischer
- Department of Cardiology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - N. Mattsson
- Department of Cardiology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - M. Storgaard
- Sports Medical Team; Team Denmark; Brøndby Denmark
| | - D. E. Høfsten
- Department of Cardiology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - N. B. Høst
- Department of Cardiology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - L. J. Andersen
- Department of Cardiology; Roskilde Hospital; Roskilde Denmark
| | - E. Prescott
- Department of Cardiology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - H. K. Rasmusen
- Department of Cardiology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
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11
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Noseworthy PA, Baggish AL. The prevalence and clinical significance of J wave patterns in athletes. J Electrocardiol 2013; 46:424-6. [DOI: 10.1016/j.jelectrocard.2013.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Indexed: 11/26/2022]
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12
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Zorzi A, ElMaghawry M, Rigato I, Cardoso Bianchini F, Crespi Ponta G, Michieli P, Migliore F, Perazzolo Marra M, Bauce B, Basso C, Schiavon M, Thiene G, Iliceto S, Corrado D. Exercise-induced normalization of right precordial negative T waves in arrhythmogenic right ventricular cardiomyopathy. Am J Cardiol 2013; 112:411-5. [PMID: 23647791 DOI: 10.1016/j.amjcard.2013.03.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 03/16/2013] [Accepted: 03/16/2013] [Indexed: 12/15/2022]
Abstract
Negative T waves (NTWs) in right precordial leads (V₁ to V₃) may be observed on the electrocardiogram (ECG) of healthy subjects but can also represent the hallmark of an underlying arrhythmogenic right ventricular cardiomyopathy (ARVC). It has been a consistent observation that NTWs usually become upright with exercise in healthy subjects without underlying heart disease. No systematic study has evaluated exercise-induced changes of NTWs in ARVC. We assessed the prevalence and relation to the clinical phenotype of exercise-induced right precordial NTWs changes in 35 patients with ARVC (19 men, mean age 22.2 ± 6.2 years). Forty-one healthy subjects with right precordial NTWs served as controls. At peak of exercise (mean power 149 ± 43 W, mean heart rate 83.6 ± 12.6% of target), NTWs persisted in 3 patients with ARVC (9%), completely normalized in 12 (34%), and partially reverted in 20 (57%). Patients with ARVC with or without NTWs normalization showed a similar clinical phenotype. The overall prevalence of right precordial T waves changes during exercise (normalization plus partial reversal) did not differ between patients with ARVC and controls (92% vs 88%, p = 1.0), whereas there was a statistically nonsignificant trend toward a greater prevalence of complete normalization in controls (56% vs 34%, p = 0.06). In conclusion, our study demonstrated that right precordial NTWs partially or completely revert with exercise in most patients with ARVC, and NTWs normalization is unrelated to the clinical phenotype. Exercise-induced NTWs changes are inaccurate in differentiating between ARVC patients and benign repolarization abnormalities.
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Affiliation(s)
- Alessandro Zorzi
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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McClaskey D, Lee D, Buch E. Outcomes among Athletes with Arrhythmias and Electrocardiographic Abnormalities: Implications for ECG Interpretation. Sports Med 2013; 43:979-91. [DOI: 10.1007/s40279-013-0074-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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14
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Tanguturi VK, Noseworthy PA, Newton-Cheh C, Baggish AL. The Electrocardiographic Early Repolarization Pattern in Athletes. Sports Med 2012; 42:359-66. [DOI: 10.2165/11630790-000000000-00000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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15
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Noseworthy PA, Weiner R, Kim J, Keelara V, Wang F, Berkstresser B, Wood MJ, Wang TJ, Picard MH, Hutter AM, Newton-Cheh C, Baggish AL. Early repolarization pattern in competitive athletes: clinical correlates and the effects of exercise training. Circ Arrhythm Electrophysiol 2011; 4:432-40. [PMID: 21543642 DOI: 10.1161/circep.111.962852] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Inferior lead early repolarization pattern (ERP) recently has been associated with sudden cardiac death. Although ERP is common among athletes, prevalence, ECG lead distribution, clinical characteristics, and effects of physical training remain uncertain. We sought to examine the nonanterior ERP in competitive athletes. METHODS AND RESULTS ERP was assessed in a cross-sectional cohort of collegiate athletes (n = 879). The relationship between ERP and cardiac structure were then examined in a longitudinal subgroup (n = 146) before and after a 90-day period of exercise training. ERP was defined as J-point elevation ≥ 0.1 mV in at least 2 leads within a nonanterior territory (inferior [II, III, aVF] or lateral territory [I, aVL, V4-V6]). Nonanterior ERP was present in 25.1% (221/879) of athletes, including the inferior subtype in 3.8% (33/879). Exercise training led to significant increases in the prevalence of ERP and the inferior subtype, but there were no associations between ERP and echocardiographic measures of left ventricular remodeling. In a multivariable model, ERP was associated with black race (odds ratio [OR], 5.84; 95% CI, 3.54 to 9.61; P < 0.001), increased QRS voltage (OR, 2.08; 95% CI, 1.71 to 2.52; P < 0.001), and slower heart rate (OR, 1.54; 95% CI, 1.26 to 1.87; P < 0.001). CONCLUSIONS Nonanterior ERP, including the inferior subtype, is common and has strong clinical associations among competitive athletes. The finding of increased ERP prevalence after intense physical training establishes a strong association between exercise and ERP.
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Affiliation(s)
- Peter A Noseworthy
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
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Abstract
Sudden cardiac death in athletes is an uncommon but extremely visible event because of the high profile of amateur and professional athletes and the expected excellent health of these athletes. However, paradoxically, athletic performance may immediately increase the risk of ventricular arrhythmias and sudden cardiac death while run reducing atherosclerosis, which thus improves cardiovascular health and longevity. In athletes younger than 30 years, the most common underlying causes are due to inherited heart disease. In the older athletes, sudden death is generally due to arrhythmias in the context of coronary artery disease. Many athletes with aborted sudden death, arrhythmia-related syncope, or high-risk genetic disorders benefit from therapy with implanted cardioverter/defibrillators (ICDs) . Although ICD therapy can effectively abort sudden death, implantation of an ICD generally prohibits an individual from all competitive athletics except low-intensity sports. The screening of athletes has been notoriously inadequate; however, the optimal screening strategies have yet to be determined. Recommendations for participation in competitive athletics generally follow the recently published 36th Bethesda Conference Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities.
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Affiliation(s)
- Mark S Link
- Division of Cardiology, Cardiac Arrhythmia Service, Tufts-New England Medical Center, Boston, MA 02111, USA.
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Giaccardi M, Camilli G, Colella A, Giannotti F, Koffi E, Lova RM, Macchi C, Gensini GF, Padeletti L, Michelucci A. XL-ECG in athlete's physiological heart hypertrophy: A time saving procedure. Int J Cardiol 2008; 124:112-4. [PMID: 17412437 DOI: 10.1016/j.ijcard.2006.11.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2006] [Accepted: 11/18/2006] [Indexed: 11/16/2022]
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Pelliccia A, Di Paolo FM, Quattrini FM, Basso C, Culasso F, Popoli G, De Luca R, Spataro A, Biffi A, Thiene G, Maron BJ. Outcomes in athletes with marked ECG repolarization abnormalities. N Engl J Med 2008; 358:152-61. [PMID: 18184960 DOI: 10.1056/nejmoa060781] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Young, trained athletes may have abnormal 12-lead electrocardiograms (ECGs) without evidence of structural cardiac disease. Whether such ECG patterns represent the initial expression of underlying cardiac disease with potential long-term adverse consequences remains unresolved. We assessed long-term clinical outcomes in athletes with ECGs characterized by marked repolarization abnormalities. METHODS From a database of 12,550 trained athletes, we identified 81 with diffusely distributed and deeply inverted T waves (> or = 2 mm in at least three leads) who had no apparent cardiac disease and who had undergone serial clinical, ECG, and echocardiographic studies for a mean (+/-SD) of 9+/-7 years (range, 1 to 27). Comparisons were made with 229 matched control athletes with normal ECGs from the same database. RESULTS Of the 81 athletes with abnormal ECGs, 5 (6%) ultimately proved to have cardiomyopathies, including one who died suddenly at the age of 24 years from clinically undetected arrhythmogenic right ventricular cardiomyopathy. Of the 80 surviving athletes, clinical and phenotypic features of hypertrophic cardiomyopathy developed in 3 after 12+/-5 years (at the ages of 27, 32, and 50 years), including 1 who had an aborted cardiac arrest. The fifth athlete demonstrated dilated cardiomyopathy after 9 years of follow-up. In contrast, none of the 229 athletes with normal ECGs had a cardiac event or received a diagnosis of cardiomyopathy 9+/-3 years after initial evaluation (P=0.001). CONCLUSIONS Markedly abnormal ECGs in young and apparently healthy athletes may represent the initial expression of underlying cardiomyopathies that may not be evident until many years later and that may ultimately be associated with adverse outcomes. Athletes with such ECG patterns merit continued clinical surveillance.
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Affiliation(s)
- Antonio Pelliccia
- Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome, Italy.
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Zito D, Pepe D, Neri B, De Rossi D, Lanatà A, Tognetti A, Scilingo EP. Wearable system-on-a-chip UWB radar for health care and its application to the safety improvement of emergency operators. ACTA ACUST UNITED AC 2007; 2007:2651-4. [PMID: 18002540 DOI: 10.1109/iembs.2007.4352874] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A new wearable system-on-a-chip UWB radar for health care systems is presented. The idea and its applications to the safety improvement of emergency operators are discussed. The system consists of a wearable wireless interface including a fully integrated UWB radar for the detection of the heart beat and breath rates, and a IEEE 802.15.4 ZigBee radio interface. The principle of operation of the UWB radar for the monitoring of the heart wall is explained hereinafter. The results obtained by the feasibility study regarding its implementation on a modern standard silicon technology (CMOS 90 nm) are reported, demonstrating (at simulation level) the effectiveness of such an approach and enabling the standard silicon technology for new generations of wireless sensors for heath care and safeguard wearable systems.
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Affiliation(s)
- Domenico Zito
- Radio-frequency and Microwave Integrated Circuits Laboratory (RFLab), Department of Information Engineering, University of Pisa, 56122 Pisa, Italy.
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Popović D, Brkić P, Nesić D, Stojiljković S, Sćepanović L, Ostojić MC. [Electrophysiological characteristics of the athlete's heart]. ACTA ACUST UNITED AC 2007; 60:156-9. [PMID: 17853728 DOI: 10.2298/mpns0704156p] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The athletic heart syndrome is characterized by morphological, functional and electrophysiological alterations as an adaptive response to vigorous physical activity. Athletes heart is predominantly associated with a programmed, intensive training. But as there are different kinds of physical activities, the degree of these changes is highly variable. ELECTROPHYSIOLOGICAL CHARACTERISTICS OF THE ATHLETE'S HEART: The response of the body to vigorous physical activity is a multiorgan system phenomenon. The integrated functioning of each of these organ systems is very important, but the cardiovascular system plays a critical role in mediating the activity. Because of that, most changes in the neurohumoral regulation predominantly affect the cardiovascular system. These changes include: depression of sympathetic activity and stimulation of parasympathetic activity, so electrophysiological characteristics of the athlete's heart must differ from the sedentary Although these facts, are well known, the athlete's heart is not a precisely defined concept. It is a gray zone between physiology, and pathology. CONCLUSION Considering the number of sudden cardiac deaths in athletes, it is needless to say how important it is to distinguish physiological changes of the heart due to physical activity, and pathological changes due to some cardiac diseases.
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Heidbüchel H, Corrado D, Biffi A, Hoffmann E, Panhuyzen-Goedkoop N, Hoogsteen J, Delise P, Hoff PI, Pelliccia A. Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part II: ventricular arrhythmias, channelopathies and implantable defibrillators. ACTA ACUST UNITED AC 2007; 13:676-86. [PMID: 17001205 DOI: 10.1097/01.hjr.0000239465.26132.29] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This consensus paper on behalf of the Study Group on Sports Cardiology of the European Society of Cardiology follows a previous one on guidelines for sports participation in competitive and recreational athletes with supraventricular arrhythmias and pacemakers. The question of imminent life-threatening arrhythmias is especially relevant when some form of ventricular rhythm disorder is documented, or when the patient is diagnosed to have inherited a pro-arrhythmogenic disorder. Frequent ventricular premature beats or nonsustained ventricular tachycardia may be a hallmark of underlying pathology and increased risk. Their finding should prompt a thorough cardiac evaluation, including both imaging modalities and electrophysiological techniques. This should allow distinguishing idiopathic rhythm disorders from underlying disease that carries a more ominous prognosis. Recommendations on sports participation in inherited arrhythmogenic conditions and asymptomatic gene carriers are also discussed: congenital and acquired long QT syndrome, short QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, arrhythmogenic right ventricular cardiomyopathy and other familial electrical disease of unknown origin. If an implantable cardioverter defibrillator is indicated, it is no substitute for the guidelines relating to the underlying pathology. Moreover, some particular recommendations for patients/athletes with an implantable cardioverter defibrillator are to be observed.
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Affiliation(s)
- Hein Heidbüchel
- Cardiology-Electrophysiology, University Hospital Gasthuisberg, Leuven, Belgium.
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Marcus FI. Prevalence of T-wave inversion beyond V1 in young normal individuals and usefulness for the diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia. Am J Cardiol 2005; 95:1070-1. [PMID: 15842973 DOI: 10.1016/j.amjcard.2004.12.060] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Revised: 12/27/2004] [Accepted: 12/27/2004] [Indexed: 01/02/2023]
Abstract
T-wave inversion in precordial leads V1 to V3 is present in <3% of apparently healthy subjects who are 19 to 45 years of age but is present in 87% of patients who have arrhythmogenic right ventricular cardiomyopathy/dysplasia. T-wave inversion in lead V2 or V3 in a young or middle-aged patients who have no apparent heart disease but do have ventricular arrhythmias of left bundle branch morphology should raise the suspicion of arrhythmogenic right ventricular cardiomyopathy/dysplasia.
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Flotats A, Serra-Grima R, Camacho V, Mena E, Borràs X, Estorch M, Tembl A, Fuertes J, Cinca J, Carrió I. Left ventricular end-diastolic volume is decreased at maximal exercise in athletes with marked repolarisation abnormalities: a continuous radionuclide monitoring study. Eur J Nucl Med Mol Imaging 2004; 32:203-10. [PMID: 15378284 DOI: 10.1007/s00259-004-1652-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2004] [Accepted: 07/19/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE Although marked repolarisation abnormalities (MRAs) are considered innocuous in trained athletes, their functional significance awaits clarification. The aim of this study was to further evaluate the pathophysiological implications of such MRAs. METHODS We compared left ventricular (LV) functional response to exhausting exercise in 39 male athletes with (n=22) or without (n=17) MRAs and with no structural cardiac abnormalities, by means of a portable radionuclide monitoring system (Vest, Capintec, Inc., Ramsey, NJ). MRAs were defined by the presence of negative T waves > or =2 mm in three or more rest ECG leads. The Vest data were averaged for 30 s and analysed at baseline and at different heart rate (HR) values (50%, 75%, 85%, 95% and 100% of peak HR), as well as at 2, 5 and 10 min of recovery. RESULTS There were no significant differences in the effect of exhausting exercise between athletes with and athletes without MRAs. However, there was a significant difference in the trend in end-diastolic volume (EDV) during exercise depending upon the group of athletes considered (p=0.05). EDV differed significantly between the two groups of athletes at peak HR (p=0.031). EDV in athletes with MRAs was lower than that in athletes without MRAs (102%+/-7% vs 107%+/-8%, p=0.034). CONCLUSION EDV is decreased at peak HR in athletes with MRAs. Such high HR values are infrequently achieved or maintained during sporting activities; therefore, in the absence of structural heart disease, MRAs should not preclude physical training and competitive availability.
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Affiliation(s)
- Albert Flotats
- Department of Nuclear Medicine, Hospital de la Santa Creu i Sant Pau, Sant Antoni M. Claret, 167, 08025, Barcelona, Spain.
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Affiliation(s)
- Barry J Maron
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA.
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Affiliation(s)
- Joseph K Choo
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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