1
|
Cardiac Morphofunctional Characteristics of Individuals with Early Repolarization Pattern: A Literature Review. J Cardiovasc Dev Dis 2022; 10:jcdd10010004. [PMID: 36661899 PMCID: PMC9861558 DOI: 10.3390/jcdd10010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
The early repolarization pattern (ERP) is an electrocardiographic phenomenon characterized by the appearance of a distinct J-wave or J-point elevation at the terminal part of the QRS complex. ERP is associated with an increased risk of ventricular arrhythmias in susceptible individuals. The cardiac morphofunctional parameters in subjects with ERP have been characterized mainly by imaging techniques, which suggests that certain changes could be identified in the background of the electrical pathomechanism: however, in this regard, current data are often contradictory or insufficiently detailed. For clarification, a more comprehensive cardiac imaging evaluation of a large patient population is necessary. This review summarizes and analyses the data from the literature related to cardiac morphofunctional characteristics in individuals with ERP.
Collapse
|
2
|
Vecchiato M, Baioccato V, Adami PE, Quinto G, Foccardi G, Slanzi G, Battista F, Neunhaeuserer D, Ermolao A. Early repolarization in adolescent athletes: A gender comparison of ECG and echocardiographic characteristics. Scand J Med Sci Sports 2022; 32:1581-1591. [PMID: 36086882 PMCID: PMC9826079 DOI: 10.1111/sms.14232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/18/2022] [Accepted: 08/26/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The early repolarization pattern (ERp) is an electrocardiographic finding previously associated with arrhythmic risk in adults. The purpose of this study is to evaluate the prevalence and characteristics of ERp in a group of adolescent athletes according to gender. Furthermore, potential associations with clinical, electrocardiographic, and echocardiographic parameters are explored. METHODS In this cross-sectional study young athletes (age < 18 years) were consecutively enrolled during the annual pre-participation evaluation, undergoing also transthoracic echocardiography assessment from January 2015 to March 2020. RESULTS The prevalence of ERp was 27% in the whole population. Athletes with ERp were more frequently men practicing endurance sports. Women with ERp showed lower heart rate at rest, greater posterior, and relative ventricular wall thickness than those without ERp. Men with ERp presented higher systolic blood pressure at peak exercise, greater septal wall thickness, and indexed left ventricular mass than those without ERp. Both genders with ERp showed increased QRS voltage and narrower QRS duration. The ERp phenotype in men was more frequently notched with higher amplitude and ascending ST segment. Women's ERp presented more frequently a slurred morphology, especially in the inferior leads, and horizontal ST slope. No differences emerged in the occurrence of arrhythmias at rest and during maximal exercise test between groups, even considering higher risk phenotypes. CONCLUSIONS ERp is an ECG finding compatible with normal cardiac adaptations to training in young athletes. ERp demonstrated gender differences regarding phenotypes previously associated with increased cardiovascular risk, not showing any differences in arrhythmias during maximal exercise test.
Collapse
Affiliation(s)
- Marco Vecchiato
- Sports and Exercise Medicine Division, Department of MedicineUniversity of PadovaPadovaItaly,Clinical Network of Sports and Exercise Medicine of the Veneto RegionPadovaItaly
| | - Veronica Baioccato
- Sports and Exercise Medicine Division, Department of MedicineUniversity of PadovaPadovaItaly,Clinical Network of Sports and Exercise Medicine of the Veneto RegionPadovaItaly
| | - Paolo Emilio Adami
- World Athletics, Medical ManagerHealth and Science DepartmentMonacoMonaco
| | - Giulia Quinto
- Sports and Exercise Medicine Division, Department of MedicineUniversity of PadovaPadovaItaly,Clinical Network of Sports and Exercise Medicine of the Veneto RegionPadovaItaly
| | - Giulia Foccardi
- Sports and Exercise Medicine Division, Department of MedicineUniversity of PadovaPadovaItaly,Clinical Network of Sports and Exercise Medicine of the Veneto RegionPadovaItaly
| | - Giulio Slanzi
- Sports and Exercise Medicine Division, Department of MedicineUniversity of PadovaPadovaItaly,Clinical Network of Sports and Exercise Medicine of the Veneto RegionPadovaItaly
| | - Francesca Battista
- Sports and Exercise Medicine Division, Department of MedicineUniversity of PadovaPadovaItaly,Clinical Network of Sports and Exercise Medicine of the Veneto RegionPadovaItaly
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, Department of MedicineUniversity of PadovaPadovaItaly,Clinical Network of Sports and Exercise Medicine of the Veneto RegionPadovaItaly
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of MedicineUniversity of PadovaPadovaItaly,Clinical Network of Sports and Exercise Medicine of the Veneto RegionPadovaItaly
| |
Collapse
|
3
|
Patel VI, Gradus-Pizlo I, Malik S, Barseghian El-Farra A, Dineen EH. Cardiodiagnostic sex-specific differences of the female athlete in sports cardiology. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 17:100149. [PMID: 38559879 PMCID: PMC10978368 DOI: 10.1016/j.ahjo.2022.100149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 04/04/2024]
Abstract
The cardiovascular care of highly active individuals and competitive athletes has developed into an important focus within the field of sports medicine. An evolving understanding of exercise-induced cardiovascular remodeling in athletes has led to a more robust characterization of physiologic adaptation versus pathological dysfunction, but this distinction is often challenging due to diagnostic commonalities. Current data reflects sporting-focused analyses of mainly male athletes, which may not be easily applicable to the female athletic heart. Increasingly female-specific cardiac dimensional and physiologic data are starting to emerge from comparative studies that may be utilized to address this growing need, and further guide individualized care. Here, we review current literature evaluating female-specific cardiovascular adaptations of the athletic heart, and formulate a discussion on cardiac remodeling, cardiodiagnostic findings, etiologic mechanisms, limitations of currently available data, and direction for future research in the cardiovascular care of female athletes.
Collapse
Affiliation(s)
- Vishal I. Patel
- Corresponding author at: Division of Cardiology, Department of Internal Medicine, University of California, Irvine, School of Medicine, 101 The City Drive South, Building 200, Room 414, Orange, CA 92868, United States of America.
| | - Irmina Gradus-Pizlo
- Division of Cardiology, University of California, Irvine, School of Medicine, Orange, CA 92868, United States of America
- Susan Samueli Integrative Health Institute, UCI Health, Orange, CA 92868, United States of America
| | - Shaista Malik
- Division of Cardiology, University of California, Irvine, School of Medicine, Orange, CA 92868, United States of America
- Susan Samueli Integrative Health Institute, UCI Health, Orange, CA 92868, United States of America
| | - Ailin Barseghian El-Farra
- Division of Cardiology, University of California, Irvine, School of Medicine, Orange, CA 92868, United States of America
- Susan Samueli Integrative Health Institute, UCI Health, Orange, CA 92868, United States of America
| | - Elizabeth H. Dineen
- Division of Cardiology, University of California, Irvine, School of Medicine, Orange, CA 92868, United States of America
- Susan Samueli Integrative Health Institute, UCI Health, Orange, CA 92868, United States of America
| |
Collapse
|
4
|
Zimmermann P, Moser O, Edelmann F, Schöffl V, Eckstein ML, Braun M. Electrical and Structural Adaption of Athlete’s Heart and the Impact on Training and Recovery Management in Professional Basketball Players: A Retrospective Observational Study. Front Physiol 2022; 13:739753. [PMID: 35222069 PMCID: PMC8874328 DOI: 10.3389/fphys.2022.739753] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/18/2022] [Indexed: 12/31/2022] Open
Abstract
IntroductionWe analyzed data of 27 professional basketball players to prove cardiac remodeling referring echocardiographic parameters, cardiopulmonary exercise testing (CPET), and 12-lead electrocardiogram (ECG) analyses. The aim of our study was to present different characteristics in the athletes, on the one hand signs of a high vagal tone in the 12-lead ECG as criteria of early repolarization (ER), furthermore echocardiographic remodeling parameters and finally the performance in CPET. Therefore, we divided the cohort into a group with signs of ER pattern in the 12-lead ECG and without these criteria and presented the differences in detail.Materials and MethodsThis was a single-center, retrospective study performed in 27 professional basketball players (age: 26.5 ± 7.5 years, male: 27, height: 197.2 ± 12 cm, weight: 100 ± 17 kg, BMI: 25.7 ± 3.4 kg/m2). All participants underwent a sports medicine checkup, ECG analysis, transthoracic echocardiographic examination, and a CPET on a cycle ergometer between 2015 and 2019 during their pre-season preparation time. All individuals were healthy people without cardiological advance anamnesis. After assessment, two groups were built based on electrocardiographic criteria of ER pattern and a group without these criteria and compared against each other for parameters of echocardiographic assessment, CPET, and 12-lead ECG analysis. Data were analyzed with Minitab statistic program (Minitab Inc., State College, PA, United States) and Graph Pad Prism 8.2.1 (279; Graph Pad Software, San Diego, CA, United States) using ANOVA testing with post-hoc testing and unpaired t-testing (p ≤ 0.05).Retrospectively additional information was collected referring to the management of training sessions, recovery time, and nutrition by interviewing the athletic training staff in order to understand the principles for individual athlete’s training management and physiological and cardiopulmonary interactions.ResultsComparing professional basketball players with ER pattern to those with no ER pattern, significant differences were found for CPET, echocardiographic, and ECG analysis (p < 0.05). Absolute and relativized peak oxygen uptake (VO2 peak; ER 4120 ± 750 ml/min (39 ± 5.4 ml/kg/min) vs. non-ER 3556 ± 393 ml/min (37.2 ± 5.3 ml/kg/min), p = 0.018) and maximum workload during CPET (ER 310 ± 51.5 Watt (2.94 ± 0.35 W/kg) vs. non-ER 271 ± 32 Watt (2.85 ± 0.49 W/kg), p = 0.026) was higher in athletes with an ER pattern. Furthermore, ER pattern athletes showed a higher enddiastolic left ventricular diameter (LVedd; ER 58.3 ± 7.9 mm vs. non-ER 53.6 ± 3.6 mm, p = 0.048) and a significantly enlarged left atrial (LA) endsystolic diameter (ER 23.33 ± 2.71 mm vs. non-ER 20.47 ± 2.29 mm, p = 0.006) as well as a significantly enlarged right atrial (RA) endsystolic diameter (ER 23.42 ± 2.15 mm vs. non-ER 20.93 ± 3.28 mm, p = 0.033). Significant differences between the two compared groups could be revealed for left ventricular mass Index (LVMI gr/m2; LVMI ER 113 gr/m2 ± 17.5 vs. LVMI non-ER 91.3 gr/m2 ± 15.1, p = 0.002), but no significant differences for the relative wall thickness were found (RWT; RWT ER 0.49 ± 0.11 vs. RWT non-ER 0.38 ± 0.06, p = 0.614).ConclusionProfessional basketball players with criteria of ER pattern showed different results in CPET and cardiac remodeling as athletes with no ER pattern. These findings should encourage the athletic training staff to emphasize the quality of an individual training schedule for each athlete based on the cardiopulmonary pre-season sport medicine checkup. Nevertheless, echocardiographic findings, ER pattern, and performance in CPET have to be interpreted referring the sport-specific and athlete’s ethnical background.
Collapse
Affiliation(s)
- Paul Zimmermann
- Department of Cardiology, Klinikum Bamberg, Bamberg, Germany
- Interdisciplinary Center of Sportsmedicine Bamberg, Klinikum Bamberg, Bamberg, Germany
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany
- *Correspondence: Paul Zimmermann,
| | - Othmar Moser
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany
- Interdisciplinary Metabolic Medicine Research Group, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, CVK, Charité University Medicine Berlin, Berlin, Germany
- German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Volker Schöffl
- Interdisciplinary Center of Sportsmedicine Bamberg, Klinikum Bamberg, Bamberg, Germany
- Department of Traumatology and Orthopaedics, Klinikum Bamberg, Bamberg, Germany
| | - Max L. Eckstein
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany
| | - Martin Braun
- Department of Cardiology, Klinikum Bamberg, Bamberg, Germany
| |
Collapse
|
5
|
Çetin S, Zeynep Akgün E, Babaoğlu K. Evaluation of Early Repolarization Pattern in Male Teenage Competitive Athletes and Association With Left Ventricular Remodeling. Turk Arch Pediatr 2021; 56:485-491. [PMID: 35110119 PMCID: PMC8848852 DOI: 10.5152/turkarchpediatr.2021.21040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Early repolarization pattern (ERP) on electrocardiogram is more common among young athletes than in the general population, and has been considered a benign finding. However, ERP has been associated with increased risk of sudden cardiac death. The objectives of this study were to evaluate ERP in teenage athletes; investigate associations between ERP and echocardiographic findings of the left ventricle (LV); and to describe the impact of different sports disciplines on ERP. METHODS ERP was assessed in male teenage athletes from sports institutions for 5 different types of sport--basketball, swimming, football, wrestling, and tennis. All had been training for at least 3 hours per week for over at least 2 years. ERP was defined as J-point elevation ≥ 1 mV in 2 contiguous and/or lateral leads. A conventional echocardiography was performed in all athletes. RESULTS ERP was evaluated in 159 athletes with a mean age of 14 (range 10-18 years). It was more common in those training with combined exercise. There was no association between ERP and echocardiographic findings of left ventricular remodeling and geometric pattern. CONCLUSION ERP is a frequent finding among teenage athletes. However, frequency varies by sports type, being more common in those training with combined exercise. It is not associated with structural echocardiographic alterations and is primarily seen as an electrophysiological change.
Collapse
Affiliation(s)
- Süha Çetin
- Department of Cardiology, Istanbul Okan University School of Medicine, Istanbul, Turkey,Corresponding author:Süha Çetin ✉
| | - Eviç Zeynep Akgün
- Department of Pediatric Cardiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Kadir Babaoğlu
- Department of Pediatric Cardiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| |
Collapse
|
6
|
Halasz G, Cattaneo M, Piepoli M, Biagi A, Romano S, Biasini V, Villa M, Cassina T, Capelli B. Early Repolarization in Pediatric Athletes: A Dynamic Electrocardiographic Pattern With Benign Prognosis. J Am Heart Assoc 2021; 10:e020776. [PMID: 34387099 PMCID: PMC8475030 DOI: 10.1161/jaha.121.020776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Early repolarization pattern (ERP) is considered a common training‐related and benign ECG finding in young adult athletes. Few data exist on ERP in the pediatric athletes population. Therefore, we aimed to evaluate the ERP prevalence, characteristics, and prognosis in pediatric athletes aged ≤16 years. Methods and Results Eight‐hundred eighty‐six consecutive pediatric athletes engaged in 17 different sports (mean age, 11.7±2.5 years; 7–16 years) were enrolled and prospectively evaluated with medical history, physical examination, resting and exercise ECGs, and transthoracic echocardiography during their preparticipation screening. Known cardiovascular diseases associated with sudden cardiac death was considered exclusion criteria. Athletes were followed up yearly for 4 years. The prevalence of ERP was 117 (13.2%), equally distributed in both sexes (P=0.072), irrespectively of body mass index and classification of sports. The most common ERP localizations were inferolateral and inferior leads (53.8% and 27.3%, respectively). Notching J‐point morphology was the most prevalent (70%), and rapidly ascending ST elevation (96%) was the most common ST‐segment morphology. Athletes with ERP were older (P<0.001) had lower rest and recovery heart rates (P<0.001), increased precordial and limb R‐wave voltages (P<0.001), increased R/S Sokolow index (P<0.001), and longer PR interval (P=0.006) in comparison with the athletes without ERP. Neither major cardiovascular nor arrhythmic events, nor sudden cardiac death were recorded over a median follow‐up of 4.2 years. One hundred seventeen (80.3%) athletes with ERP exhibited a persistent ERP. ERP localization and J‐point morphology changed during follow‐up in 11 (11.7%) and 17 (18%) of athletes, respectively. Conclusions ERP is common in pediatric athletes. It was mostly located in the inferolateral leads and associated with concave ascending ST segment with other training‐related ECG changes. The lack of either sudden cardiac death or cardiomyopathies linked to sudden cardiac death over follow‐up suggests that in pediatric athletes, ERP may be considered a benign training‐related ECG phenomenon with a potential dynamic pattern.
Collapse
Affiliation(s)
- Geza Halasz
- Cardiology Department Guglielmo Da Saliceto Hospital Piacenza Italy.,Cardiology Department Cardiocentro Ticino Lugano Switzerland
| | - Mattia Cattaneo
- Cardiology Department Cardiocentro Ticino Lugano Switzerland
| | - Massimo Piepoli
- Cardiology Department Guglielmo Da Saliceto Hospital Piacenza Italy
| | - Andrea Biagi
- Cardiology Department Guglielmo Da Saliceto Hospital Piacenza Italy
| | - Silvio Romano
- Cardiology Department of Life Health & Environmental Sciences University of L'Aquila L'Aquila Italy
| | | | - Michele Villa
- Cardiovascular Intensive Care Unit Cardiocentro Ticino Lugano Switzerland
| | - Tiziano Cassina
- Cardiovascular Intensive Care Unit Cardiocentro Ticino Lugano Switzerland
| | - Bruno Capelli
- Sport and Exercise Medicine Cardiocentro Ticino Lugano Switzerland
| |
Collapse
|
7
|
Ilodibia TF, Odia JO. Evaluation of the Seattle and International Criteria in elite Nigerian athletes. J Electrocardiol 2021; 68:14-23. [PMID: 34273803 DOI: 10.1016/j.jelectrocard.2021.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The Seattle Criteria (SC) and International Criteria (IC) were both developed for cardiovascular pre-participation screening in young athletes. Neither set of Criteria has been systematically evaluated in high level indigenous black African athletes. OBJECTIVES (1) To determine the pattern of ECG findings in athletes of the University of Port Harcourt, Nigeria; (2) To determine the predictors of altered repolarization in these athletes; and (3) To evaluate the diagnostic performance of the SC and IC in these athletes. METHODS 77 athletes (42 males, 35 females) without any known cardiovascular disease were recruited alongside 78 similarly healthy non-athletic controls (44 males, 34 females). The two groups were matched for age, sex, and body mass index. Clinical assessment was according to the Lausanne Recommendations. All subjects underwent electrocardiography and echocardiography. Analysis with the IC was retrospective. RESULTS The most common physiological finding in the athletes was sinus bradycardia (n = 37; 48.1%). Early repolarization pattern, ERP (n = 27, 35.1% with SC; n = 42, 54.5% with IC), and dome-shaped ST-segment elevation with T-wave inversion (DSSTWI) in leads V1-4 (n = 21, 29.3% with both criteria), were also prevalent. Compared to controls, only male sex (adjusted odds ratio 2.89, 1.05 to 7.97, p = .040 with SC; OR 2.57, 1.19 to 5.53, p = .016 with IC) and ECG LVH (OR 2.82, 1.18 to 6.75, p = .020 with SC alone) independently predicted ERP, while athletic status (OR 4.76, 1.66 to 13.68, p = .004 with both criteria) alone had a significant multivariate association with DSSTWI. Three athletes (3.9%) had abnormal ECGs while two (2.6%) had major echocardiographic abnormalities. The sensitivity, specificity and accuracy of the SC for structural cardiac disease in the athletes were 50.0% (1.3 to 98.7), 97.3% (90.7 to 99.7) and 96.1% (89.0 to 99.2) respectively. The respective figures for the IC were 50.0% (1.3 to 98.7), 98.7% (92.8 to 100) and 97.4% (90.9 to 99.7). CONCLUSION Both criteria showed high accuracy in this Black African cohort with a high frequency of electrocardiographic repolarization changes. While ERP seems to be primarily related to black ethnicity, DSSTWI appears to be a bona fide marker of Athlete's Heart in blacks.
Collapse
Affiliation(s)
- Tochukwu F Ilodibia
- Division of Cardiology, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, East-West Road, Opposite Alakahia Junction, Rivers State, PMB, 6173, Nigeria.
| | - James O Odia
- Division of Cardiology, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, East-West Road, Opposite Alakahia Junction, Rivers State, PMB, 6173, Nigeria
| |
Collapse
|
8
|
Çöllüoğlu T, Önalan O, Çakan F. The diagnostic value of 2D-speckle tracking echocardiography for identifying subclinical ventricular dysfunction in subjects with early repolarization pattern. Echocardiography 2021; 38:1141-1148. [PMID: 34114242 DOI: 10.1111/echo.15128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/07/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Early repolarization pattern (ERP) can exist a silent substrate for arrhytmic events in accordance with the previous studies which have shown there has been evidence of morphological changes in left ventricle (LV) in ERP subjects. Despite structural changes in ERP subjects, it has not exactly known whether a change in LV functional parameters occur in ERP. The aim of our study was to investigate LV functional parameters in ERP athletes evaluated by 2D- speckle tracking echocardiography (2D-STE). METHOD In this study, athletes with ERP (n = 50) and athletes without ERP (n = 50) were recruited between April 2018 and September 2018. For each case, 2D- TTE and 2D- STE evaluation were performed by the same cardiologist. RESULTS Left ventricle mean global longitudinal strain (GLS) (P < .001) and GLS at all apical chamber views (P < .001), longitudinal peak systolic strain rate (SRS) at A3C (P: .011), early diastolic strain rate (SRE) at A3C (P < .001) and late diastolic strain rate (SRA) at A3C (P: .034) in the ERP athletes were significantly lower than those in the athletes without ERP. LV basal segment circumferential SRS (P: .002) and SRE (P: .006) were significantly lower in ERP athletes compared to athletes without ERP. LV mechanical dispersion was significantly higher in ERP athletes compared to athletes without ERP (P < .001). CONCLUSION Our study suggests ERP can be more associated with impaired LV longitudinal function than circumferential function. In addition, both LV inferolateral region and basal segment can be more affected functionally in ERP athletes.
Collapse
Affiliation(s)
- Tuğçe Çöllüoğlu
- Cardiology Department, KBU Educational and Research Hospital, Karabük, Turkey
| | - Orhan Önalan
- Cardiology Department, KBU Educational and Research Hospital, Karabük, Turkey
| | - Fahri Çakan
- Cardiology Department, KBU Educational and Research Hospital, Karabük, Turkey
| |
Collapse
|
9
|
Frederiksen TC, Krogh Christiansen M, Clausen L, Kjaerulf Jensen H. Early repolarization pattern in adult females with eating disorders. Ann Noninvasive Electrocardiol 2021; 26:e12865. [PMID: 34114301 PMCID: PMC8411689 DOI: 10.1111/anec.12865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/01/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The risk of cardiovascular death is increased in patients with eating disorders (ED), but the background for this is unknown. Early repolarization pattern (ERP) on the electrocardiogram (ECG) has been associated with increased risk of sudden cardiac death. METHODS We investigated the prevalence of ERP in 233 female patients with anorexia nervosa (AN) and bulimia nervosa (BN) (age 18-35 years) compared with 123 healthy female controls. RESULTS Early repolarization pattern was present in 52 (22%) of ED patients (16 (15%) AN patients and 36 (29%) BN patients) and 17 (14%) of healthy controls. When adjusting for age, BMI, heart rate, use of selective serotonin reuptake inhibitors (SSRI), and potassium level, the odds ratio (OR) for ERP was 2.1 (95% CI 1.1-4.2, p = .03). There was an increased prevalence of inferolateral ERP in patients with ED compared with healthy controls (OR = 4.3, 95% CI 1.7-11.3, p = .003) as well as ERP with a downward/horizontal sloping ST segment (OR = 3.1, 95% CI 1.3-7.6, p = .01). Additionally, J-point elevation >0.2 mV was more prevalent in patients with ED (OR = 3.3, 95% CI 1.1-9.7, p = .03). CONCLUSION The prevalence of ERP was increased in patients with ED compared with healthy controls. This finding may provide a possible explanation for the increased cardiovascular mortality in ED patients.
Collapse
Affiliation(s)
- Tanja Charlotte Frederiksen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Health, Aarhus, Denmark
| | | | - Loa Clausen
- Department of Clinical Medicine, Aarhus University, Health, Aarhus, Denmark.,Research Unit, Department of Child- and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Kjaerulf Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Health, Aarhus, Denmark
| |
Collapse
|
10
|
Ji HY, Hu N, Liu R, Zhou HR, Gao WL, Quan XQ. Worldwide prevalence of early repolarization pattern in general population and physically active individuals: A meta-analysis. Medicine (Baltimore) 2021; 100:e25978. [PMID: 34087840 PMCID: PMC8183793 DOI: 10.1097/md.0000000000025978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/28/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The early repolarization pattern (ERP) has recently been associated with cardiac events such as ventricular arrhythmias and sudden cardiac death. However, estimates of the prevalence of ERP vary widely, especially between the general population and physically active individuals. We performed this systematic review and meta-analysis to quantitatively evaluate the worldwide prevalence of ERP in the general population and physically active individuals. METHODS We thoroughly searched the PubMed, EMBASE, Web of science, the Cochrane Library, and Scopus databases for relevant studies published until December 20, 2020. Studies in which prevalence was presented or could be estimated from eligible data were included. The pooled prevalence was analyzed using a random-effect model. RESULTS Finally, we included 29 studies (182,135 subjects) in the general population and 14 studies (8087 subjects) in the physically active individuals. The worldwide pooled prevalence of ERP in the general population was 11.6% (95% confidence interval [CI]: 10.0%-13.3%). The incidence of ERP was 17.0% and 6.2% in men and women, respectively. The prevalence was 20.9% in blacks, 13.4% in Asians, and 10.1% in Caucasians. Additionally, the prevalence of ERP in physically active individuals was 33.9% (95% CI: 25.3%-42.6%). CONCLUSION A significant difference in the worldwide prevalence of ERP is revealed in this study. The ERP is highly prevalent in men, blacks, and physically active individuals.
Collapse
Affiliation(s)
| | | | - Rui Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Hai-Rong Zhou
- Department of General Practice, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, China
| | - Wei-Liang Gao
- Department of General Practice, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, China
| | - Xiao-Qing Quan
- Department of General Practice, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, China
| |
Collapse
|
11
|
Schoenfeld J, Schindler MJ, Haller B, Holdenrieder S, Nieman DC, Halle M, La Gerche A, Scherr J. Prospective long-term follow-up analysis of the cardiovascular system in marathon runners: study design of the Pro-MagIC study. BMJ Open Sport Exerc Med 2020; 6:e000786. [PMID: 32704381 PMCID: PMC7371022 DOI: 10.1136/bmjsem-2020-000786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Prolonged strenuous exercise training may result in structural, functional and electrical cardiac remodelling, as well as vascular and myocardial injuries. However, the extent to which high-volume, intense exercise is associated with arrhythmias, myocardial fibrosis, coronary heart disease and pathological alterations of the vasculature remains unknown. In addition, there is no clear consensus on the clinical significance of these exercise-induced changes. Previous studies typically used cross-sectional designs and examined exercise-induced cardiovascular changes in small cohorts of athletes for up to 3–7 days of recovery. Long-term longitudinal studies investigating cardiovascular changes induced by prolonged strenuous exercise in large cohorts of athletes are needed to improve scientific understanding in this area. Methods and analysis In this prospective observational monocenter study, 277 participants of the Beer, Marathon, Genetics, Inflammation and the Cardiovascular System (Be-MaGIC) study (ClinicalTrials.gov: NCT00933218) will be invited to participate in this 10-year follow-up study. A minimum target sample size of 130 participants will be included in the study. Participating athletes will be examined via the following: anthropometry, resting electrocardiography and echocardiography, blood sampling, retinal vessel diameters, carotid sonography and cardiopulmonary exercise testing, including exercise electrocardiography. Discussion This longitudinal study will provide comprehensive data on physiological changes in the cardiovascular system and the development of pathologies after a 10-year period of prolonged and strenuous endurance exercise. Since the participants will have engaged in a wide range of training loads and competitive race events, this study will provide useful risk factor determinants and training load cut-off values. The primary endpoint is the association between the exercise-induced increase in cardiac troponin during the Munich marathon 2009 and the decline in right ventricular ejection fraction over the next 10 years. Trial registration number NCT04166903.
Collapse
Affiliation(s)
- Julia Schoenfeld
- Preventive Sports Medicine and Sports Cardiology, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Bavaria, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Bavaria, Germany
| | - Michael Johannes Schindler
- Preventive Sports Medicine and Sports Cardiology, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Bavaria, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Bavaria, Germany
| | - Stefan Holdenrieder
- Department of Laboratory Medicine, German Heart Center at Munich Technical University, Munich, Bayern, Germany
| | - David Christopher Nieman
- Human Performance Laboratory, Appalachian State University and North Carolina Research Campus, Kannapolis, North Carolina, USA
| | - Martin Halle
- Preventive Sports Medicine and Sports Cardiology, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Bavaria, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Bavaria, Germany
| | - André La Gerche
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Johannes Scherr
- University Center for Preventive and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| |
Collapse
|
12
|
Teumer A, Trenkwalder T, Kessler T, Jamshidi Y, van den Berg ME, Kaess B, Nelson CP, Bastiaenen R, De Bortoli M, Rossini A, Deisenhofer I, Stark K, Assa S, Braund PS, Cabrera C, Dominiczak AF, Gögele M, Hall LM, Ikram MA, Kavousi M, Lackner KJ, Müller C, Münzel T, Nauck M, Padmanabhan S, Pfeiffer N, Spector TD, Uitterlinden AG, Verweij N, Völker U, Warren HR, Zafar M, Felix SB, Kors JA, Snieder H, Munroe PB, Pattaro C, Fuchsberger C, Schmidt G, Nolte IM, Schunkert H, Pramstaller PP, Wild PS, van der Harst P, Stricker BH, Schnabel RB, Samani NJ, Hengstenberg C, Dörr M, Behr ER, Reinhard W. KCND3 potassium channel gene variant confers susceptibility to electrocardiographic early repolarization pattern. JCI Insight 2019; 4:131156. [PMID: 31600170 PMCID: PMC6962032 DOI: 10.1172/jci.insight.131156] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/08/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUNDThe presence of an early repolarization pattern (ERP) on the surface ECG is associated with risk of ventricular fibrillation and sudden cardiac death. Family studies have shown that ERP is a highly heritable trait, but molecular genetic determinants are unknown.METHODSTo identify genetic susceptibility loci for ERP, we performed a GWAS and meta-analysis in 2,181 cases and 23,641 controls of European ancestry.RESULTSWe identified a genome-wide significant (P < 5 × 10-8) locus in the potassium voltage-gated channel subfamily D member 3 (KCND3) gene that was successfully replicated in additional 1,124 cases and 12,510 controls. A subsequent joint meta-analysis of the discovery and replication cohorts identified rs1545300 as the lead SNP at the KCND3 locus (OR 0.82 per minor T allele, P = 7.7 × 10-12) but did not reveal additional loci. Colocalization analyses indicate causal effects of KCND3 gene expression levels on ERP in both cardiac left ventricle and tibial artery.CONCLUSIONSIn this study, we identified for the first time to our knowledge a genome-wide significant association of a genetic variant with ERP. Our findings of a locus in the KCND3 gene provide insights not only into the genetic determinants but also into the pathophysiological mechanism of ERP, discovering a promising candidate for functional studies.FUNDINGThis project was funded by the German Center for Cardiovascular Research (DZHK Shared Expertise SE081 - STATS). For detailed funding information per study, see the Supplemental Acknowledgments.
Collapse
Affiliation(s)
- Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - Teresa Trenkwalder
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thorsten Kessler
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany
| | - Yalda Jamshidi
- Genetics Research Centre, Institute of Molecular and Clinical Sciences, Saint George's University of London, London, United Kingdom
| | - Marten E van den Berg
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Bernhard Kaess
- Medizinische Klinik I, St. Josefs-Hospital, Wiesbaden, Germany
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, Leicester, United Kingdom.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Rachel Bastiaenen
- Cardiology Clinical Academic Group, Institute of Molecular and Clinical Sciences, Saint George's, University of London, London, United Kingdom
| | - Marzia De Bortoli
- Eurac Research, Institute for Biomedicine, affiliated with the University of Lübeck, Bolzano, Italy
| | - Alessandra Rossini
- Eurac Research, Institute for Biomedicine, affiliated with the University of Lübeck, Bolzano, Italy
| | - Isabel Deisenhofer
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany
| | - Klaus Stark
- Department of Genetic Epidemiology, University Regensburg, Regensburg, Germany
| | - Solmaz Assa
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Peter S Braund
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, Leicester, United Kingdom.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Claudia Cabrera
- Clinical Pharmacology, William Harvey Research Institute, and.,NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom.,Centre for Translational Bioinformatics, William Harvey Research Institute, Barts and the London, London, United Kingdom, and School of Medicine and Dentistry, Charterhouse Square, London, United Kingdom
| | - Anna F Dominiczak
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Martin Gögele
- Eurac Research, Institute for Biomedicine, affiliated with the University of Lübeck, Bolzano, Italy
| | - Leanne M Hall
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, Leicester, United Kingdom.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany.,DZHK, partner site Rhine-Main, Mainz, Germany
| | | | - Christian Müller
- University Heart & Vascular Center Hamburg, Hamburg, Germany.,DZHK, partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Thomas Münzel
- DZHK, partner site Rhine-Main, Mainz, Germany.,Cardiology I, Center for Cardiology, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany
| | - Matthias Nauck
- German Center for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Andre G Uitterlinden
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Niek Verweij
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Uwe Völker
- German Center for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany.,Interfaculty Institute for Genetics and Functional Genomics and
| | - Helen R Warren
- Clinical Pharmacology, William Harvey Research Institute, and.,NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Mobeen Zafar
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Stephan B Felix
- German Center for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Jan A Kors
- Department of Medical Informatics, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Patricia B Munroe
- Clinical Pharmacology, William Harvey Research Institute, and.,NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Cristian Pattaro
- Eurac Research, Institute for Biomedicine, affiliated with the University of Lübeck, Bolzano, Italy
| | - Christian Fuchsberger
- Eurac Research, Institute for Biomedicine, affiliated with the University of Lübeck, Bolzano, Italy
| | - Georg Schmidt
- Innere Medizin I, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.,DZHK, partner site Munich Heart Alliance, Munich, Germany
| | - Ilja M Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Heribert Schunkert
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany.,DZHK, partner site Munich Heart Alliance, Munich, Germany
| | - Peter P Pramstaller
- Eurac Research, Institute for Biomedicine, affiliated with the University of Lübeck, Bolzano, Italy
| | - Philipp S Wild
- DZHK, partner site Rhine-Main, Mainz, Germany.,Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Renate B Schnabel
- University Heart & Vascular Center Hamburg, Hamburg, Germany.,DZHK, partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, Leicester, United Kingdom.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Marcus Dörr
- German Center for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Elijah R Behr
- Cardiology Clinical Academic Group, Institute of Molecular and Clinical Sciences, Saint George's University of London, London, United Kingdom.,Saint George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Wibke Reinhard
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany
| |
Collapse
|
13
|
Lacalzada‐Almeida J, García‐Niebla J. Early repolarization and echocardiography: Some aspects to consider. Ann Noninvasive Electrocardiol 2019; 24:e12680. [DOI: 10.1111/anec.12680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/05/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Javier García‐Niebla
- Servicios Sanitarios del Área de Salud de El Hierro Valle del Golfo Health Center El Hierro Spain
| |
Collapse
|
14
|
Trenkwalder T, Rübsamen N, Schmitt VH, Arnold N, Kaess BM, Sinning CR, Zeller T, Beutel ME, Schmidtmann I, Nickels S, Pfeiffer N, Leuschner A, Münzel T, Lackner KJ, Hengstenberg C, Blankenberg S, Wild PS, Reinhard W, Schnabel R. Left ventricular geometry and function in early repolarization: results from the population-based Gutenberg Health Study. Clin Res Cardiol 2019; 108:1107-1116. [DOI: 10.1007/s00392-019-01445-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 02/19/2019] [Indexed: 12/18/2022]
|
15
|
Reinhard W, Trenkwalder T, Haller B, Meindl C, Schoenfeld J, Kaess BM, Hengstenberg C, Schunkert H, Pressler A, Halle M, Scherr J. The early repolarization pattern: Echocardiographic characteristics in elite athletes. Ann Noninvasive Electrocardiol 2018; 24:e12617. [PMID: 30427098 DOI: 10.1111/anec.12617] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/05/2018] [Accepted: 10/08/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The electrocardiographic early repolarization (ER) pattern is associated with idiopathic ventricular fibrillation and increased long-term cardiovascular mortality. Whether structural cardiac aberrations influence the phenotype is unclear. Since ER is particularly common in athletes, we evaluated its prevalence and investigated predisposing echocardiographic characteristics and cardiopulmonary exercise capacity in a cohort of elite athletes. METHODS A total of 623 elite athletes (age 21 ± 5 years) were examined during annual preparticipation screening from 2006 until 2012 including electrocardiography, echocardiography, and exercise testing. ECGs were analyzed with focus on ER. All athletes participated in a clinical follow-up. RESULTS The prevalence of ER was 17% (108/623). ER-positive athletes were predominantly male (71%, 77/108), showed a lower heart rate (57.1 ± 9.3 bpm versus 60.0 ± 11.2 bpm; p = 0.015) and a higher lean body mass compared to ER-negative participants (88.1% ± 5.6% versus 86.5% ± 6.3%; p = 0.015). Echocardiographic measurements and cardiopulmonary exercise capacity in male and female athletes with and without ER largely showed similar results. Only the notching ER subtype (n = 15) was associated with an increased left atrial diameter (OR 7.01, 95%CI 1.65-29.83; p = 0.008), a higher left ventricular mass (OR 1.02, 95%CI 1.00-1.03; p = 0.038) and larger relative heart volume (OR 1.01, 95%CI 1.00-1.01; p = 0.01). During a follow-up of 7.4 ± 1.5 years, no severe cardiovascular event occurred in the study sample. CONCLUSIONS In elite athletes presence of ER is not associated with distinct alterations in echocardiography and cardiopulmonary exercise. Athletes presenting with ER are rather male, lean with a low heart rate.
Collapse
Affiliation(s)
- Wibke Reinhard
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Teresa Trenkwalder
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Bernhard Haller
- Institut für Medizinische Informatik, Statistik und Epidemiologie, Technical University Munich, Munich, Germany
| | - Christine Meindl
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Julia Schoenfeld
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich (TUM), Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Bernhard M Kaess
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.,Medizinische Klinik I, St. Josefs-Hospital, Wiesbaden, Germany
| | - Christian Hengstenberg
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.,Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Heribert Schunkert
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Axel Pressler
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Martin Halle
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich (TUM), Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Johannes Scherr
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich (TUM), Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| |
Collapse
|