title: Clinical meaning of isolated increase of QRS voltages in hypertrophic cardiomyopathy versus athlete's heart.
abstract: Recent consensus documents have provided modern criteria for interpretation of the athlete's ECG, which are based on a better definition of physiological versus abnormal ECG changes. The aim of these modern criteria is to lower the traditionally high number of false positives and to reduce unnecessary and expensive investigations, maintaining the sensitivity for identification of cardiac diseases at risk of sudden cardiac death during sports such as hypertrophic cardiomyopathy (HCM). This article reviews the published studies regarding the ECG changes associated with HCM ("pathologic hypertrophy") and athlete's heart ("physiologic hypertrophy"), with particular reference to the prevalence and clinical significance of the ECG pattern of isolated increase of QRS voltages. Taken together the results of the available studies show that ECG provides good accuracy for differentiating HCM from athlete's heart and allows to preserve the ECG power for detection of athletes with HCM. Patients with either completely normal ECGs or showing isolated QRS voltage criteria for LV hypertrophy have a less severe HCM phenotype, which is associated with a lower arrhythmic risk. These scientific data support the current recommendation that further cardiovascular tests including echocardiography are not systematically indicated in trained athletes showing an isolated increase of QRS voltages.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova.
authors.forename: Chiara
authors.initials: C
authors.lastname: Calore
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zorzi
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova. Electronic address: domenico.corrado@unipd.it.
authors.forename: Domenico
authors.initials: D
authors.lastname: Corrado
mesh_terms: D056352:Athletes / Q000145:classification; D059267:Cardiomegaly, Exercise-Induced / Q000502:physiology*; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis* / Q000503:physiopathology*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D003955:Diagnostic Tests, Routine / Q000379:methods; D004562:Electrocardiography / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D018580:Mandatory Testing / Q000379:methods; D008403:Mass Screening / Q000379:methods*; D010808:Physical Examination / Q000379:methods; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D013177:Sports; D013178:Sports Medicine / Q000379:methods
keywords: Athlete's ECG; Athlete's heart; ECG screening; Hypertrophic cardiomyopathy