Defining the Normal Spectrum of Electrocardiographic and Left Ventricular Adaptations in Mixed-Race Male Adolescent Soccer Players

Malhotra, Aneil; Oxborough, David; Rao, Prashant; Finocchiaro, Gherardo; Dhutia, Harshil; Prasad, Vivek; Miller, Chris; Keavney, Bernard; Papadakis, Michael; Sharma, Sanjay

doi:10.1161/circulationaha.120.049740

Cited by 16 publications

(24 citation statements)

References 4 publications

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“…Of the 51 papers included in analysis, 32 papers discussed Black athletes. Of the included papers, 26 found that there was a significant difference between Black athlete and Caucasian athlete ECGs [ 9 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ], but six papers concluded there were no significant differences between athletes [ 38 , 39 , 40 , 41 , 42 , 43 ]. Of the 26 papers that reported differences, 19 identified specific differences between groups of athletes, while the other seven papers noted an overall rate of abnormal ECGs noted by various criteria.…”

Section: Resultsmentioning

confidence: 99%

“…The most common ECG difference between Black and Caucasian athletes in the papers analyzed was TWI. A higher prevalence of TWI in Black athletes vs. Caucasian athlete populations was found in 10 papers, varying from 2.6% to 22.8% of Black athletes vs. 0% to 5.0% of Caucasian athletes [ 15 , 16 , 17 , 22 , 24 , 25 , 27 , 28 , 32 , 37 ]. Anterior TWI beyond V2 was noted as more common in Black athletes than Caucasian athletes in six papers, found in 3.7%–14.3% of Black athletes and 0.6%–2.0% in Caucasian athletes [ 15 , 16 , 27 , 28 , 32 , 36 ].…”

Section: Resultsmentioning

confidence: 99%

“…A higher prevalence of TWI in Black athletes vs. Caucasian athlete populations was found in 10 papers, varying from 2.6% to 22.8% of Black athletes vs. 0% to 5.0% of Caucasian athletes [ 15 , 16 , 17 , 22 , 24 , 25 , 27 , 28 , 32 , 37 ]. Anterior TWI beyond V2 was noted as more common in Black athletes than Caucasian athletes in six papers, found in 3.7%–14.3% of Black athletes and 0.6%–2.0% in Caucasian athletes [ 15 , 16 , 27 , 28 , 32 , 36 ]. Inferior TWI, in lead II, and aVF was found to be more common in five studies, ranging from 1.3% to 6.1% in Black athletes and from 0.5% to 1.7% in Caucasian athletes [ 15 , 16 , 27 , 28 , 33 ].…”

Section: Resultsmentioning

confidence: 99%

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The Impact of Ethnicity on Athlete ECG Interpretation: A Systematic Review

Davis

Semsarian

Orchard

et al. 2022

JCDD

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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%) and anterior TWI (3.7–14.3% vs. 0.6–2%). 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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The Impact of Ethnicity on Athlete ECG Interpretation: A Systematic Review

Davis

Semsarian

Orchard

et al. 2022

JCDD

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“…Prior studies, also cross-sectional in design, reported differences in cardiac phenotypes by country of origin37 and international geographic region38 in the comparison of black and non-black athletes. More recently, a large cross-sectional study of 3000 mixed-race athletes (defined as having one black and one white parent) reported increased concentric LV remodelling in the mixed-race athlete cohort 39. In the general population, across the age spectrum, C-LVH is more commonly observed among black individuals 4 5 40.…”

Section: Discussionmentioning

confidence: 99%

Association between race and maladaptive concentric left ventricular hypertrophy in American-style football athletes

et al. 2021

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ObjectivesAmerican-style football (ASF) athletes are at risk for the development of concentric left ventricular hypertrophy (C-LVH), an established cardiovascular risk factor in the general population. We sought to address whether black race is associated with acquired C-LVH in collegiate ASF athletes.MethodsCollegiate ASF athletes from two National Collegiate Athletic Association Division-I programmes were recruited as freshmen between 2014 and 2019 and analysed over 3 years. Demographics (neighbourhood family income) and repeated clinical characteristics and echocardiography were recorded longitudinally at multiple timepoints. A mixed-modelling approach was performed to evaluate acquired C-LVH in black versus white athletes controlling for playing position (linemen (LM) and non-linemen (NLM)), family income, body weight and blood pressure.ResultsAt baseline, black athletes (N=124) were more often NLM (72% vs 54%, p=0.005) and had lower median neighbourhood family income ($54 119 vs $63 146, p=0.006) compared with white athletes (N=125). While both black and white LM demonstrated similar increases in C-LVH over time, among NLM acquired C-LVH was more common in black versus white athletes (postseason year-1: N=14/89 (16%) vs N=2/68 (3%); postseason year-2: N=9/50 (18%) vs N=2/32 (6%); postseason year-3: N=8/33 (24%) vs N=1/13 (8%), p=0.005 change over time). In stratified models, black race was associated with acquired C-LVH in NLM (OR: 3.70, 95% CI 1.12 to 12.21, p=0.03) and LM was associated with acquired C-LVH in white athletes (OR: 3.40, 95% CI 1.03 to 11.27, p=0.048).ConclusionsIndependent of family income and changes in weight and blood pressure, black race was associated with acquired C-LVH among collegiate ASF NLM and LM was associated with acquired C-LVH in white athletes.

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“…To the best of our knowledge, the electrocardiographic reference values we have provided represent a precise topography of the physiological evolution of the athlete's heart over time during adolescence and bring to light the growing prevalence of cardiovascular adaptations to intense and regular training in mixed sports athletes, in which hemodynamic responses and long-term impact on cardiac output and remodeling are balanced between dynamic and static components (24). Recently, several articles have been published on the electrocardiographic characteristics of adolescent athletes (25)(26)(27), but none have evaluated the evolving difference between 2-year age classes or provided specific reference values in adolescent athletes with a normal ECG and a normal echocardiographic evaluation. We believe that our electrocardiographic nomograms could be extremely useful in defining normal reference limits and z-scores among different groups of age to aid in differentiating training adaptations from normal growth and maturation, which may be of particular importance when an inherited disease is suspected (Figure 3).…”

Section: The Usefulness Of Ecg Nomogramsmentioning

confidence: 97%

Age-Related Electrocardiographic Characteristics of Male Junior Soccer Athletes

Sciarra

Biondi‐Zoccai

Maffessanti

et al. 2022

Front. Cardiovasc. Med.

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IntroductionVery limited data exist on normal age-related ECG variations in adolescents and no data have been published regarding the ECG anomalies induced by intensive training, which are relevant in pre-participation screening for sudden cardiac death prevention in the adolescent athletic population. The purpose of this study was to establish normal age-related electrocardiographic measurements (P wave duration, PR interval, QRS duration, QT, and QTc interval) grouped according to 2-year age intervals.MethodsA total of 2,151 consecutive healthy adolescent Soccer athletes (trained for a mean of 7.2 ± 1.1 h per week, 100% male Caucasians, mean age 12.4 ± 1.4 years, range 7–18) underwent pre-participation screening, which included ECG and transthoracic echocardiography in a single referral center.ResultsTheir heart rate progressively slowed as age increased (p < 0.001, ranging from 80.8 ± 13.2 to 59.5 ± 10.2 bpm), as expected. The P wave, PR interval, and QRS duration significantly increased in older age classes (p = 0.019, p = 0.001, and p < 0.001, respectively), and after Bonferroni's correction, the difference remained significant in all age classes for QRS duration. The QTc interval diminished progressively with increasing age (p = 0.003) while the QT interval increased progressively (p < 0.001).ConclusionsSignificant variations in the normal ECG characteristics of young athletes exist between different age groups related to increasing age and training burden, thus, age-specific reference values could be adopted, as already done for echocardiographic measurements, and may help to further discriminate potentially pathologic conditions.

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Defining the Normal Spectrum of Electrocardiographic and Left Ventricular Adaptations in Mixed-Race Male Adolescent Soccer Players

Cited by 16 publications

References 4 publications

The Impact of Ethnicity on Athlete ECG Interpretation: A Systematic Review

The Impact of Ethnicity on Athlete ECG Interpretation: A Systematic Review

Association between race and maladaptive concentric left ventricular hypertrophy in American-style football athletes

Age-Related Electrocardiographic Characteristics of Male Junior Soccer Athletes

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