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Ferrari F, da Silveira AD, Saffi MAL, Ziegelmann PK, Aleixo HC, Dilda GD, Emed LGM, Magalhães FCO, Cardoso FB, Arantes MM, Bassan F, Braga F, da Silva HC, Guerra FEF, Soares LG, Dornelles M, Arruda IZ, Mourão LFRM, Júnior JN, Vieira CTF, Torres V, Meira DT, de Lima GFI, Murara PBC, Coimbra FPL, Barbosa FCD, Teixeira MF, Alô ROB, Herdy AH, Froelicher VF, Stein R. Resting ECG findings in male Brazilian soccer players of different ethnicities: Results from the B-Pro Foot ECG study. J Sci Med Sport 2025; 28:263-269. [PMID: 39672716 DOI: 10.1016/j.jsams.2024.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 11/22/2024] [Accepted: 11/27/2024] [Indexed: 12/15/2024]
Abstract
OBJECTIVES To compare the prevalence of training-related ECG findings in white, mixed-race, and black male Brazilian soccer players. DESIGN Multicenter observational study. METHODS This study involved athletes aged 15 to 35 years from 82 professional clubs across Brazil's five regions. It included athletes who underwent preparticipation cardiovascular screening between February 2002 and September 2023. RESULTS A total of 6125 players (median age: 18) were included (2496 white, 2004 mixed-race, and 1625 black). Ninety-seven percent of the ECGs were normal. Sinus bradycardia was observed in 50.1 %, while left ventricular hypertrophy in 35.1 %, with a higher prevalence in black players (41.7 %) compared to white (31.7 %) or mixed-race (34.1 %) players. Early repolarization was most prevalent among black athletes (48.2 %) compared to white (34.3 %) and mixed-race (40.5 %) athletes. The mean PR interval was 153.0 ms, higher in black players (156.8 ms) than in white (150.6 ms) or mixed-race (152.8 ms) players. Black athletes had more first-degree AV block (4.1 %) compared to mixed-race athletes (2.7 %). Conversely, white athletes (15.4 %) had more incomplete right bundle branch block than mixed-race (11.4 %) or black (9.8 %) athletes. The 'African/Afro-Caribbean pattern' was found in 1.8 % of black players. CONCLUSIONS Ninety-seven percent of male Brazilian soccer players had normal ECG patterns. Training-related ECG findings were more common in black players compared to white or mixed-race players. The 'African/Afro-Caribbean pattern' was rare in black players.
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Affiliation(s)
- Filipe Ferrari
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Anderson D da Silveira
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Science, Health and Performance Department, Grêmio Foot-Ball Porto Alegrense, Porto Alegre, RS, Brazil
| | - Marco A L Saffi
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Patrícia K Ziegelmann
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Graduate Program in Epidemiology, Department of Statistics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Haroldo C Aleixo
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Luiz G M Emed
- Instituto de Neurologia de Curitiba, Curitiba, PR, Brazil
| | | | | | | | - Fernando Bassan
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brazil
| | - Fabrício Braga
- Laboratório de Performance Humana, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Luciano G Soares
- Clínica Biocorfit Reabilitação Cardíaca Pulmonar e Metabólica, Goiânia, GO, Brazil
| | - Márcio Dornelles
- Science, Health and Performance Department, Grêmio Foot-Ball Porto Alegrense, Porto Alegre, RS, Brazil
| | - Ivan Z Arruda
- Science, Health and Performance Department, Grêmio Foot-Ball Porto Alegrense, Porto Alegre, RS, Brazil
| | | | | | | | - Valdir Torres
- Santa Casa de Campo Grande, Campo Grande, MS, Brazil
| | - Diogo T Meira
- Fluminense Football Club, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | - Rodrigo O B Alô
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| | - Artur H Herdy
- Instituto de Cardiologia de Santa Catarina, Florianópolis, SC, Brazil
| | - Victor F Froelicher
- Stanford University, Department of Cardiovascular Medicine, Palo Alto, CA, United States of America
| | - Ricardo Stein
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Ashikaga K, Manabe T, Tomori A, Endo N, Kamahara K. Differences in athlete's left ventricular morphology by sex and sports discipline categories in elite Japanese athletes. PHYSICIAN SPORTSMED 2025:1-10. [PMID: 39905295 DOI: 10.1080/00913847.2025.2463320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 01/28/2025] [Accepted: 02/03/2025] [Indexed: 02/06/2025]
Abstract
OBJECTIVES The cardiac morphology of elite athletes is related to sports disciplines and race; however, no studies have examined the effects of sports discipline on East Asian athletes. Therefore, this study aimed to assess left ventricular (LV) remodeling using transthoracic echocardiography in elite Japanese athletes and establish standard values for the indicators of the cardiac morphology of elite athletes in East Asia, considering the influence of body size. METHODS We retrospectively evaluated 1,363 elite Japanese athletes who underwent electrocardiography and transthoracic echocardiography between January 2011 and December 2021. The athletes were assigned to four sports discipline categories (skill, power, mixed, and endurance). We evaluated the differences in LV volume and mass between the groups for each sex. RESULTS The LV end-diastolic volume (LVEDV) and LV mass indexed to the body surface area (BSA) in the endurance group (LVEDV/BSA: 72.3 ± 11.4 mL/m2 in males and 68.7 ± 11.0 mL/m2 in females, LV mass/BSA: 121.1 ± 19.1 g/m2 in males and 106.5 ± 18.0 g/m2 in females) were significantly larger than those of any other groups. Both values were affected by sex, BSA, and endurance sport type, whereas only LV mass was affected by age. CONCLUSION Cardiac remodeling is proportional to the sport type, with a significantly greater effect in athletes playing endurance sports. The remodeling is particularly evident in the left ventricle; however, the corresponding remodeling is also observed in other heart chambers. Cardiac remodeling in elite Japanese athletes is similar to that observed in elite athletes of other races, except for the changes in LV wall thickness.
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Affiliation(s)
- Kohei Ashikaga
- Department of Sports Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Sports Medical Center, Japan Institute of Sports Science, Tokyo, Japan
| | - Tomohiro Manabe
- Sports Medical Center, Japan Institute of Sports Science, Tokyo, Japan
- Sports Medicine Research Center, Keio University, Yokohama, Kanagawa, Japan
| | - Anna Tomori
- Sports Medical Center, Japan Institute of Sports Science, Tokyo, Japan
| | - Naoya Endo
- Sports Medical Center, Japan Institute of Sports Science, Tokyo, Japan
| | - Kazuyuki Kamahara
- Sports Medical Center, Japan Institute of Sports Science, Tokyo, Japan
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Roslan A, Stanislaus R, Yee Sin T, Aris FA, Ashari A, Shaparudin AA, Rahimi Shah WFW, Hui Beng K, Tjen Jhung L, Tantawi Jauhari Aktifanus A, Kamsani SH, Rusani BI, Win NT, Abdul Rani MNH, Ai Ming T, Aedrus N, Azman K, Halim MNA, Zainal MDY, Hussein K, Shariff Hamid M, Puji A, Khairuddin A. Echocardiography and strain analysis in Malaysian elite athletes versus young healthy adults. IJC HEART & VASCULATURE 2023; 47:101242. [PMID: 37576081 PMCID: PMC10422669 DOI: 10.1016/j.ijcha.2023.101242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/28/2023] [Accepted: 06/26/2023] [Indexed: 08/15/2023]
Abstract
Background Athletes have changes that can mimic pathological cardiomyopathy. Methods Echocardiographic study of 50 male, female athletes (MA, FA) and non-athletes (MNA, FNA) age 18 to 30 years. These athletes participate in sports with predominantly endurance component. All participants exhibit no known medical illnesses or symptoms. Results MA have thicker wall (IVSd) than MNA. No MA have IVSd > 1.2 cm and no FA have IVSd > 1.0 cm. Left ventricle internal dimension (LVIDd), left ventricle end diastolic volume index (LVEDVi) is bigger in athletes. None have LVIDd > 5.8 cm. Right ventricle fractional area change (FAC) is lower in athletes. (MA vs MNA, p = 0.013, FA vs FNA, p = 0.025). Athletes have higher septal and lateral e' (Septal e'; MA 13.57 ± 2.66 cm/s vs MNA 11.46 ± 2.93 cm/s, p < 0.001, Lateral e'; MA 17.17 ± 3.07 cm/s vs MNA 14.82 ± 3.14 cm/s, p < 0.001), (Septal e'; FA 13.46 ± 2.32 cm/s vs FNA 12.16 ± 2.05 cm/s, p = 0.04, Lateral e'; FA 16.92 ± 2.97 cm/s vs FNA 15.44 ± 2.29 cm/s, p = 0.006).No difference in Global longitudinal (GLS), Right ventricle free wall (RVFWS) and Global circumferential strain (GCS). Left atrial reservoir (LArS) and left atrial booster strain (LAbS) is smaller in athletes. (LArS, MA 44.12 ± 9.55% vs MNA 52.95 ± 11.17%, p < 0.001 LArS, FA 48.07 ± 10.06% vs FNA 53.64 ± 8.99%, p = 0.004), (LAbS, MA 11.59 ± 5.13% vs MNA 17.35 ± 5.27%, p < 0.001 LAbS FA 11.77 ± 4.65% vs FNA 15.30 ± 4.19%, p < 0.001). Conclusion Malaysian athletes have thicker wall and bigger left ventricle than controls. No athletes have IVSd > 1.2 cm and/or LVIDd > 5.8 cm. There is no difference in GLS, RVFWS and GCS but athletes have smaller LArS and LAbS.
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Affiliation(s)
- Aslannif Roslan
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Rohith Stanislaus
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Tey Yee Sin
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Faten A. Aris
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Afif Ashari
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | | | - Koh Hui Beng
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Lee Tjen Jhung
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Suraya H. Kamsani
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Beni I. Rusani
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Nay T. Win
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Tan Ai Ming
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Noraminah Aedrus
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Kartina Azman
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | | | | | | | - Arshad Puji
- Institut Sukan Negara, Kuala Lumpur, Malaysia
| | - Ahmad Khairuddin
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
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Cuenza L, Cheong AP, Yeo TJ. Improving electrocardiogram interpretation in Asian athletes: A call to action. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:225-227. [PMID: 38904518 DOI: 10.47102/annals-acadmedsg.2023110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Affiliation(s)
- Lucky Cuenza
- ManilaMed Sports and Exercise Medicine Centre, Manila, Philippines
- Cardinal Santos Medical Center Sports Medicine Institute: The MVP Clinic, Manila, Philippines
| | | | - Tee Joo Yeo
- Department of Cardiology, National University Heart Centre, Singapore
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Lim B, Lim B, Hamzah F, Lim AT, Ng CS, Tan B, Tong KL. Comparison of four electrocardiographic criteria for the detection of cardiac abnormalities in Singapore athletes. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:230-238. [PMID: 38904520 DOI: 10.47102/annals-acadmedsg.2022191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Introduction Sudden cardiac death in athletes is a rare occurrence, the most common cause being hypertrophic cardiomyopathy, which increases the risk of sustained ventricular tachycardia or ventricular fibrillation. Most of these young athletes are asymptomatic prior to the cardiac arrest. Several electrocardiogram criteria such as the European Society of Cardiology group 2 Criteria changes, Seattle Criteria, Refined Criteria, and most recently the 2017 International Criteria, have sought to improve the accuracy of identifying these at-risk athletes during pre-participation screening while minimising unnecessary investigations for the majority of athletes at low risk.We aimed to compare the above four criteria in our Singapore athlete population to identify which criterion performed the best in detecting cardiac abnormalities on echocardiography. Method Out of 1,515 athletes included in Changi General Hospital, Singapore registry between June 2007 and June 2014, the electrocardiograms of 270 athletes with further cardiac investigations were analysed. We compared the above four electrocardiographic criteria to evaluate which performed best for detecting cardiac abnormalities on echocardiography in our Southeast Asian athlete population. Results The European Society of Cardiology, Seattle, Refined and 2017 International Criteria had a sensitivity of 20%, 0%, 20% and 5%, respectively; a specificity of 64%, 93%, 84% and 97%, respectively; a positive predictive value of 4%, 0%, 9% and 11%, respectively; and a negative predictive value of 91%, 92%, 93% and 93%, respectively for detecting abnormalities on echocardiography. Conclusion The latest 2017 International Criteria performed the best as it had the highest specificity and positive predictive value, joint highest negative predictive value, and lowest false positive rate.
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Affiliation(s)
- Benji Lim
- Department of Cardiology, Changi General Hospital, Singapore
| | - Baoying Lim
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Fadzil Hamzah
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Ang Tee Lim
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Chung Sien Ng
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Benedict Tan
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Khim Leng Tong
- Department of Cardiology, Changi General Hospital, Singapore
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Harris CS, Froelicher VF, Hadley D, Wheeler MT. Guide to the Female Student Athlete ECG: A Comprehensive Study of 3466 Young, Racially Diverse Athletes. Am J Med 2022; 135:1478-1487.e4. [PMID: 35981651 DOI: 10.1016/j.amjmed.2022.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES The 12-lead electrocardiogram (ECG) is used in the preparticipation screening examination for athletes. Despite known differences in ECG findings by sex, only QTc prolongation is given a sex-specific threshold. We hypothesize that our large dataset-with diversity in age, race, and sport participation-can be utilized to improve ECG screening in female student athletes. METHODS Computerized 12-lead ECGs were recorded and analyzed in female athletes who underwent preparticipation screening examination between June 2010 and September 2021. The quantitative, empirical 2017 international criteria for electrocardiographic interpretation were compared with either the 99th percentile in our cohort or the percentile that corresponded to the known disease prevalence. RESULTS Of 3466 female athletes with ECGs as part of preparticipation screening examination, the 2017 international criteria classified 2.1% of athletes with at least one ECG abnormality requiring cardiological evaluation. Rates were similar across age, race/ethnicity, and sporting discipline. Using ranges based on our population, 2.7% of athletes would require additional workup. Surprisingly, ST depression up to 0.03 mV was a normal finding in this cohort. If RS voltage extremes were considered findings requiring follow-up, an additional 9.6% of the athlete population would be flagged using current definitions. This number decreases to 2.7% if using the 99th percentile in this cohort. CONCLUSION These results highlight a difference in the reported prevalence of ECG abnormalities when comparing empirically derived thresholds to statistically derived ranges. Consideration of new metrics specific to the female athlete population has the potential to further refine athlete ECG screening.
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The Impact of Ethnicity on Athlete ECG Interpretation: A Systematic Review. J Cardiovasc Dev Dis 2022; 9:jcdd9060183. [PMID: 35735812 PMCID: PMC9225578 DOI: 10.3390/jcdd9060183] [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] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022] Open
Abstract
Athlete ECG interpretation criteria have been developed and refined from research in athlete populations; however, current guidelines are based on available data primarily from Caucasian and Black athletes. This study aimed to assess the impact of ethnicity on ECG interpretation in athletes. A systematic review was conducted of the MEDLINE, EMBASE, Scopus, SPORTDiscus, and Web of Science databases, for papers that assessed athlete screening ECGs and compared findings on the basis of ethnicity. Fifty-one papers which compared ECGs from various ethnicities were included. Most studies assessed Black athletes against Caucasian athletes and found a greater prevalence of T-wave inversion (TWI) (2.6–22.8% vs. 0–5.0%) and anterior TWI (3.7–14.3% vs. 0.6–2.0%). Black athlete subgroups in Africa had TWI (20–40%) and anterior TWI (4.3–18.7%) at a higher prevalence than other Black athletes. Athletes who were defined as mixed-race, Asian, and Pacific Islander are potentially more like Black athletes than Caucasian athletes. Black ethnicity is known to have an impact on the accurate interpretation of athlete ECGs; however, there is nuance related to origin of both parents. Asian and Pacific Islander origin also may impact athlete ECG interpretation. Further research is required to assist in distinguishing abnormal and normal athlete ECGs in different ethnic populations.
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