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Vecchiato M, Quinto G, Borasio N, Palermi S, Berton G, Battista F, Gasperetti A, Ermolao A, Neunhaeuserer D. The Fragmented QRS Complex in Lead V 1: Time for an Update of the Athlete's ECG? J Cardiovasc Transl Res 2024; 17:24-32. [PMID: 37906369 PMCID: PMC10896913 DOI: 10.1007/s12265-023-10448-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023]
Abstract
Differentiating between ECG patterns related to athletes' heart remodeling and pathological findings is a challenge in sports cardiology. As the significance of fragmented complex in athletes remains uncertain, this study aimed to assess the presence of fragmented QRS in lead V1 (fQRSV1) among young athletes and its association with heart adaptations and arrhythmias. Young athletes referred for annual pre-participation screening receiving a maximal exercise testing and transthoracic echocardiography from January 2015 to March 2021 were included. The study included 684 young athletes. The prevalence of fQRSV1 was 33%. Subjects with fQRSV1 had higher exercise capacity and indexes of right ventricular function and remodeling. Among highly trained athletes, the fQRSV1 group demonstrated also increased left ventricular wall thickness. No significant association existed between fQRSV1 and exercise-induced arrhythmias, even in highly trained athletes. The high prevalence of fQRSV1 in young athletes is associated with training-induced heart adaptations but not exercise-induced ventricular arrhythmias.
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Affiliation(s)
- Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Giulia Quinto
- Sports and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Nicola Borasio
- Sports and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131, Naples, Italy
| | - Giampaolo Berton
- Division of Cardiology, Ospedale Alto Vicentino, 36014, Santorso (VI), Italy
| | - Francesca Battista
- Sports and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Andrea Gasperetti
- Sports and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Via Giustiniani 2, 35128, Padua, Italy.
- University of Padova, Department of Medicine, Via Nicolò Giustiniani, 2, 35128, Padua, Italy.
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Via Giustiniani 2, 35128, Padua, Italy
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Riding NR, Dorobantu DM, Williams CA, Stuart G, Fritsch P, Wilson MG, Mossialos E, Pieles G. Protecting the stars of tomorrow: do international cardiovascular preparticipation screening policies account for the paediatric athlete? A systematic review and quality appraisal. Br J Sports Med 2023; 57:371-380. [PMID: 36332982 DOI: 10.1136/bjsports-2022-105659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE (1) Identify and review current policies for the cardiovascular screening of athletes to assess their applicability to the paediatric population and (2) evaluate the quality of these policy documents using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. DESIGN Systematic review and quality appraisal of policy documents. DATA SOURCES A systematic search of PubMed, MEDLINE, Scopus, Web of Science, SportDiscus and CINAHL. ELIGIBILITY CRITERIA FOR SELECTING STUDIES An article was included if it was a policy/position statement/guideline/consensus or recommendation paper relating to athletes and cardiovascular preparticipation screening. RESULTS AND SUMMARY Of the 1630 articles screened, 13 met the inclusion criteria. Relevance to paediatric athletes was found to be high in 3 (23%), moderate in 6 (46%) and low in 4 (31%), and only 2 provide tailored guidance for the athlete aged 12-18 years. A median 5 related citations per policy investigated solely paediatric athletes, with study designs most commonly being retrospective (72%). AGREEII overall quality scores ranged from 25% to 92%, with a median of 75%. The lowest scoring domains were rigour of development; (median 32%) stakeholder involvement (median 47%) and Applicability (median 52%). CONCLUSION Cardiac screening policies for athletes predominantly focus on adults, with few providing specific recommendations for paediatric athletes. The overall quality of the policies was moderate, with more recent documents scoring higher. Future research is needed in paediatric athletes to inform and develop cardiac screening guidelines, to improve the cardiac care of youth athletes.
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Affiliation(s)
- Nathan R Riding
- Bristol Medical School, University of Bristol, Bristol, UK.,Institute of Sport and Exercise Health (ISEH), University College London, London, UK
| | - Dan-Mihai Dorobantu
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, UK.,Population Health Sciences, University of Bristol, Bristol, UK.,Congenital Heart Unit, Bristol Royal Hospital for Children and Heart Institute, Bristol, UK
| | - Craig A Williams
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, UK
| | - Graham Stuart
- Congenital Heart Unit, Bristol Royal Hospital for Children and Heart Institute, Bristol, UK.,National Institute for Health Research Cardiovascular Biomedical Research Centre, Bristol Heart Institute, Bristol, UK
| | | | - Mathew G Wilson
- Institute of Sport and Exercise Health (ISEH), University College London, London, UK.,Athlete Health and Performance Research Centre and the Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Elias Mossialos
- Department of Health Policy, London School of Economics, London, UK
| | - Guido Pieles
- Institute of Sport and Exercise Health (ISEH), University College London, London, UK .,Athlete Health and Performance Research Centre and the Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Nurminen J, Pérez-Riera AR, de Luna AB, Nikus K, Lyytikäinen LP, Huhtala H, Eskola M, Kähönen M, Jula A, Lehtimäki T, Hernesniemi J. The S1S2S3 electrocardiographic pattern - Prevalence and relation to cardiovascular and pulmonary diseases in the general population. J Electrocardiol 2022; 73:113-119. [PMID: 35839706 DOI: 10.1016/j.jelectrocard.2022.07.003] [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: 02/25/2022] [Revised: 06/13/2022] [Accepted: 07/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is lack of studies exploring the incidence and association with diseases of the S1S2S3 electrocardiogram (ECG) pattern in the general population. SUBJECTS AND METHODS This population study included 6299 individuals aged 30+, and explored the prevalence and association between S1S2S3 and cardiovascular and pulmonary diseases. Criteria for the S1S2S3-I and S1S2S3-II ECG pattern were fulfilled when there was an S wave in the leads I, II and III, and the S-wave amplitude was greater than the R-wave amplitude in one or two of the leads, respectively. RESULTS The S1S2S3-I ECG pattern was found in 2332 subjects (36.9%). After age adjustment, hypertension was associated with S1S2S3-I (Odds ratio [OR] 1.25, 95% CI 1.12-1.41, p < 0.001). This age-adjusted association was statistically significant among men but not among women (OR 1.37, 1.16-1.62, p < 0.001 and OR 1.13, 0.97-1.33, p = 0.126, respectively). The S1S2S3-II ECG pattern was present in 193 subjects (3.1%). After age adjustment, heart failure proved to be associated with S1S2S3-II (OR 1.85, 1.18-2.90, p = 0.007). Dividing the population by sex, resulted in a statistically significant age-adjusted association for men but not for women (OR 2.30, 1.22-4.33, p = 0.010 and OR 1.59, 0.83-3.03, p = 0.159, respectively). Interactions with sex were statistically non-significant. CONCLUSION In the general adult population, the prevalence of the S1S2S3 ECG pattern is markedly affected by the diagnostic ECG criteria. The S1S2S3-I pattern was associated with hypertension, while S1S2S3-II was associated with heart failure, and both associations were enhanced in men. The associations with other studied cardiovascular and pulmonary diseases were minor and not clinically useful for risk stratification.
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Affiliation(s)
- Joonas Nurminen
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland
| | - Andrés Ricardo Pérez-Riera
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | - Antonio Bayés de Luna
- Cardiovascular Research Foundation. Cardiovascular ICCC- Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Finland.
| | - Leo-Pekka Lyytikäinen
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Finland
| | - Markku Eskola
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland; Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Antti Jula
- National Institute for Health and Welfare, Helsinki, Finland
| | - Terho Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Finland
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Floria M, Parteni N, Neagu AI, Sascau RA, Statescu C, Tanase DM. Incomplete right bundle branch block: Challenges in electrocardiogram diagnosis. Anatol J Cardiol 2021; 25:380-384. [PMID: 34100724 DOI: 10.5152/anatoljcardiol.2021.84375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mariana Floria
- Internal Medicine Clinic, "Dr. Iacob Czihac" Military Emergency Clinical Hospital; Iasi-Romania;Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy; Iasi-Romania
| | - Noela Parteni
- Internal Medicine Clinic, "Dr. Iacob Czihac" Military Emergency Clinical Hospital; Iasi-Romania;Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy; Iasi-Romania
| | - Alexandra Ioana Neagu
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy; Iasi-Romania;"Prof. Dr. George I.M. Georgescu" Institute of Cardiovascular Disease; Iasi-Romania
| | - Radu Andy Sascau
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy; Iasi-Romania;"Prof. Dr. George I.M. Georgescu" Institute of Cardiovascular Disease; Iasi-Romania
| | - Cristian Statescu
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy; Iasi-Romania;"Prof. Dr. George I.M. Georgescu" Institute of Cardiovascular Disease; Iasi-Romania
| | - Daniela Maria Tanase
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy; Iasi-Romania;Internal Medicine Clinic, "St. Spiridon" County Clinical Emergency Hospital; Iasi-Romania
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Ollitrault P, Pellissier A, Reboursière E, Milliez P, Hodzic A. The “V1 continuum” on the surface ECG of apparently healthy athletes. Scand J Med Sci Sports 2020; 30:2275-2276. [DOI: 10.1111/sms.13801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Pierre Ollitrault
- Department of Cardiology Caen University Hospital Normandie Univ UniCaen Caen France
| | - Arnaud Pellissier
- Department of Cardiology Caen University Hospital Normandie Univ UniCaen Caen France
| | - Emmanuel Reboursière
- Clinical Physiology and Sports Medecine Department Caen University Hospital Normandie Univ UniCaen INSERM COMETE Caen France
| | - Paul Milliez
- Department of Cardiology Caen University Hospital Normandie Univ UniCaen Caen France
| | - Amir Hodzic
- Clinical Physiology and Sports Medecine Department Caen University Hospital Normandie Univ UniCaen INSERM COMETE Caen France
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