title: Electrical and structural adaptations of the paediatric athlete's heart: a systematic review with meta-analysis.
abstract: OBJECTIVE
  To describe the electrocardiographic (ECG) and echocardiographic manifestations of the paediatric athlete's heart, and examine the impact of age, race and sex on cardiac remodelling responses to competitive sport.
  
  
  METHODS
  Systematic review with meta-analysis.
  
  
  METHODS
  Six electronic databases were searched to May 2016: MEDLINE, PubMed, EMBASE, Web of Science, CINAHL and SPORTDiscus.
  
  
  METHODS
  (1) Male and/or female competitive athletes, (2) participants aged 6-18 years, (3) original research article published in English language.
  
  
  RESULTS
  Data from 14 278 athletes and 1668 non-athletes were included for qualitative (43 articles) and quantitative synthesis (40 articles). Paediatric athletes demonstrated a greater prevalence of training-related and training-unrelated ECG changes than non-athletes. Athletes ≥14 years were 15.8 times more likely to have inferolateral T-wave inversion than athletes <14 years. Paediatric black athletes had significantly more training-related and training-unrelated ECG changes than Caucasian athletes. Age was a positive predictor of left ventricular (LV) internal diameter during diastole, interventricular septum thickness during diastole, relative wall thickness and LV mass. When age was accounted for, these parameters remained significantly larger in athletes than non-athletes. Paediatric black athletes presented larger posterior wall thickness during diastole (PWTd) than Caucasian athletes. Paediatric male athletes also presented larger PWTd than females.
  
  
  CONCLUSIONS
  The paediatric athlete's heart undergoes significant remodelling both before and during 'maturational years'. Paediatric athletes have a greater prevalence of training related and training-unrelated ECG changes than non-athletes, with age, race and sex mediating factors on cardiac electrical and LV structural remodelling.
authors.affiliation: Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.|Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK.
authors.forename: Gavin
authors.initials: G
authors.lastname: McClean
authors.affiliation: Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
authors.forename: Nathan R
authors.initials: NR
authors.lastname: Riding
authors.affiliation: Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.|Division of Physiotherapy, Linköping University, Linköping, Sweden.|School of Allied Health, La Trobe University, Melbourne, Australia.
authors.forename: Clare L
authors.initials: CL
authors.lastname: Ardern
authors.affiliation: Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: Farooq
authors.affiliation: National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit, Congenital Heart Unit, Bristol Royal Hospital for Children and Bristol Heart Institute, Bristol, UK.|School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: Guido E
authors.initials: GE
authors.lastname: Pieles
authors.affiliation: Department of Sports Medicine, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
authors.forename: Victoria
authors.initials: V
authors.lastname: Watt
authors.affiliation: Department of Sports Medicine, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
authors.forename: Carmen
authors.initials: C
authors.lastname: Adamuz
authors.affiliation: Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK.
authors.forename: Keith P
authors.initials: KP
authors.lastname: George
authors.affiliation: Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK.
authors.forename: David
authors.initials: D
authors.lastname: Oxborough
authors.affiliation: Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.|Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK.|Research Institute of Sport and Exercise Sciences, University of Canberra, Australia.
authors.forename: Mathew G
authors.initials: MG
authors.lastname: Wilson
mesh_terms: D000222:Adaptation, Physiological; D000293:Adolescent; D000367:Age Factors; D056352:Athletes; D044383:Black People; D002648:Child; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000502:physiology*; D006801:Humans; D008297:Male; D012737:Sex Factors; D020257:Ventricular Remodeling; D044465:White People
keywords: Athlete’s heart; Cardiology; Paediatrics