title: Clinical significance of electrocardiographic right ventricular hypertrophy in athletes: comparison with arrhythmogenic right ventricular cardiomyopathy and pulmonary hypertension.
abstract: OBJECTIVE
  Pre-participation cardiovascular screening of young athletes may prevent sports-related sudden cardiac deaths. Recognition of physiological electrocardiography (ECG) changes in healthy athletes has improved the specificity of screening while maintaining sensitivity for disease. The study objective was to determine the clinical significance of electrocardiographic right ventricular hypertrophy (RVH) in athletes.
  
  
  RESULTS
  Between 2010 and 2012, 868 subjects aged 14-35 years (68.8% male) were assessed using ECG and echocardiography (athletes; n = 627, sedentary controls; n = 241). Results were compared against patients with established right ventricular (RV) pathology (arrhythmogenic right ventricular cardiomyopathy, n = 68; pulmonary hypertension, n = 30). Sokolow-Lyon RVH (R[V1]+S[V5orV6] > 1.05 mV) was more prevalent in athletes than controls (11.8 vs. 6.2%, P = 0.017), although RV wall thickness (RVWT) was similar (4.0 ± 1.0 vs. 3.9 ± 0.9 mm, P = 0.18). Athletes exhibiting electrocardiographic RVH were predominantly male (95.9%), and demonstrated similar RV dimensions and function to athletes with normal electrocardiograms (RVWT; 4.0 ± 1.1 vs. 4.0 ± 0.9 mm, P = 0.95, RV basal dimension; 42.7 ± 5.2 vs. 42.1 ± 5.9 mm, P = 0.43, RV fractional area change; 40.6 ± 7.6 vs. 42.2 ± 8.1%, P = 0.14). Sensitivity and specificity of Sokolow-Lyon RVH for echocardiographic RVH (>5 mm) were 14.3 and 88.2%, respectively. Further evaluation including cardiac magnetic resonance imaging did not diagnose right ventricular pathology in any athlete. None of the cardiomyopathic or pulmonary hypertensive patients exhibited voltage RVH without additional ECG abnormalities.
  
  
  CONCLUSIONS
  Electrocardiographic voltage criteria for RVH are frequently fulfilled in healthy athletes without underlying RV pathology, and should not prompt further evaluation if observed in isolation. Recognition of this phenomenon should reduce the burden of investigations after pre-participation ECG screening without compromising sensitivity for disease.
authors.affiliation: Division of Cardiovascular Sciences, St George's University of London (SGUL), Cranmer Terrace, SW17 0RE London, UK.
authors.forename: Abbas
authors.initials: A
authors.lastname: Zaidi
authors.forename: Saqib
authors.initials: S
authors.lastname: Ghani
authors.forename: Nabeel
authors.initials: N
authors.lastname: Sheikh
authors.forename: Sabiha
authors.initials: S
authors.lastname: Gati
authors.forename: Rachel
authors.initials: R
authors.lastname: Bastiaenen
authors.forename: Brendan
authors.initials: B
authors.lastname: Madden
authors.forename: Michael
authors.initials: M
authors.lastname: Papadakis
authors.forename: Hariharan
authors.initials: H
authors.lastname: Raju
authors.forename: Matthew
authors.initials: M
authors.lastname: Reed
authors.forename: Rajan
authors.initials: R
authors.lastname: Sharma
authors.forename: Elijah R
authors.initials: ER
authors.lastname: Behr
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis*; D016022:Case-Control Studies; D042241:Early Diagnosis; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis*; D017380:Hypertrophy, Right Ventricular / Q000175:diagnosis*; D008297:Male; D012017:Referral and Consultation; D012307:Risk Factors; D013177:Sports / Q000502:physiology*; D055815:Young Adult
keywords: Echocardiography; Electrocardiography; Exercise