title: Clinical significance of abnormal electrocardiographic patterns in trained athletes.
abstract: BACKGROUND-The prevalence, clinical significance, and determinants of abnormal ECG patterns in trained athletes remain largely unresolved. METHODS AND RESULTS-We compared ECG patterns with cardiac morphology (as assessed by echocardiography) in 1005 consecutive athletes (aged 24+/-6 years; 75% male) who were participating in 38 sporting disciplines. ECG patterns were distinctly abnormal in 145 athletes (14%), mildly abnormal in 257 (26%), and normal or with minor alterations in 603 (60%). Structural cardiovascular abnormalities were identified in only 53 athletes (5%). Larger cardiac dimensions were associated with abnormal ECG patterns: left ventricular end-diastolic cavity dimensions were 56. 0+/-5.6, 55.4+/-5.7, and 53.7+/-5.7 mm (P<0.001) and maximum wall thicknesses were 10.1+/-1.4, 9.8+/-1.3, and 9.3+/-1.4 mm (P<0.001) in distinctly abnormal, mildly abnormal, and normal ECGs, respectively. Abnormal ECGs were also most associated with male sex, younger age (<20 years), and endurance sports (cycling, rowing/canoeing, and cross-country skiing). A subset of athletes (5% of the 1005) showed particularly abnormal or bizarre ECG patterns, but no evidence of structural cardiovascular abnormalities or an increase in cardiac dimensions. CONCLUSIONS-Most athletes (60%) in this large cohort had ECGs that were completely normal or showed only minor alterations. A variety of abnormal ECG patterns occurred in 40%; this was usually indicative of physiological cardiac remodeling. A small but important subgroup of athletes without cardiac morphological changes showed striking ECG abnormalities that suggested cardiovascular disease; however, these changes were likely an innocent consequence of long-term, intense athletic training and, therefore, another component of athlete heart syndrome. Such false-positive ECGs represent a potential limitation to routine ECG testing as part of preparticipation screening.
authors.affiliation: Institute of Sports Science, Department of Medicine, Italian National Olympic Committee, Rome, Italy. ISS_Medicina@coni.it
authors.forename: A
authors.initials: A
authors.lastname: Pelliccia
authors.forename: B J
authors.initials: BJ
authors.lastname: Maron
authors.forename: F
authors.initials: F
authors.lastname: Culasso
authors.forename: F M
authors.initials: FM
authors.lastname: Di Paolo
authors.forename: A
authors.initials: A
authors.lastname: Spataro
authors.forename: A
authors.initials: A
authors.lastname: Biffi
authors.forename: G
authors.initials: G
authors.lastname: Caselli
authors.forename: P
authors.initials: P
authors.lastname: Piovano
mesh_terms: D000293:Adolescent; D000328:Adult; D000375:Aging / Q000502:physiology; D002318:Cardiovascular Diseases / Q000503:physiopathology; D002648:Child; D015331:Cohort Studies; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010806:Physical Education and Training; D012727:Sex Characteristics; D013177:Sports