Defining the Normal Spectrum of Electrocardiographic and Left Ventricular Adaptations in Mixed-Race Male Adolescent Soccer Players
2020; Lippincott Williams & Wilkins; Volume: 143; Issue: 1 Linguagem: Inglês
10.1161/circulationaha.120.049740
ISSN1524-4539
AutoresAneil Malhotra, David Oxborough, Prashant Rao, Gherardo Finocchiaro, Harshil Dhutia, Vivek Prasad, Chris Miller, Bernard Keavney, Michael Papadakis, Sanjay Sharma,
Tópico(s)Cardiovascular and exercise physiology
ResumoHomeCirculationVol. 143, No. 1Defining the Normal Spectrum of Electrocardiographic and Left Ventricular Adaptations in Mixed-Race Male Adolescent Soccer Players Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessLetterPDF/EPUBDefining the Normal Spectrum of Electrocardiographic and Left Ventricular Adaptations in Mixed-Race Male Adolescent Soccer Players Aneil Malhotra, MB, BChir, MA, MRCP(UK), MSc, PhD, David Oxborough, MSc, PhD, Prashant Rao, MRCP(UK), MD, Gherardo Finocchiaro, MD, MRCP(UK), Harshil Dhutia, BSc, MBBS, MRCP(UK), MD, Vivek Prasad, BSc, Chris Miller, BSc, MBBS, MRCP(UK), PhD, Bernard Keavney, BSc, BM BCh, DM, Michael Papadakis, BSc, MRCP(UK), MD and Sanjay Sharma, BSc, MRCP(UK), MD Aneil MalhotraAneil Malhotra Aneil Malhotra, St George's, University of London, Cranmer Terrace, London, United Kingdom SW17 0RE. Email E-mail Address: [email protected] https://orcid.org/0000-0002-8670-3764 Cardiology Clinical Academic Group, St George's, University of London, United Kingdom(A.M., M.P., S.S.). Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom(A.M., C.M., B.K.). Manchester University National Health ServiceFoundation Trust, Manchester Academic Health Science Centre, United Kingdom(A.M., V.P., C.M., B.K.). , David OxboroughDavid Oxborough Research Institute for Sports and Exercise Science, Liverpool John Moore's University, United Kingdom(D.O.). , Prashant RaoPrashant Rao Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA(P.R.). , Gherardo FinocchiaroGherardo Finocchiaro Cardiothoracic Centre, Guy's and St Thomas' Hospital, London, United Kingdom(G.F.). , Harshil DhutiaHarshil Dhutia Department of Cardiology, Glenfield Hospital, Leicester, United Kingdom(H.D.). , Vivek PrasadVivek Prasad Manchester University National Health ServiceFoundation Trust, Manchester Academic Health Science Centre, United Kingdom(A.M., V.P., C.M., B.K.). , Chris MillerChris Miller Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom(A.M., C.M., B.K.). Manchester University National Health ServiceFoundation Trust, Manchester Academic Health Science Centre, United Kingdom(A.M., V.P., C.M., B.K.). , Bernard KeavneyBernard Keavney https://orcid.org/0000-0001-9573-0812 Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom(A.M., C.M., B.K.). Manchester University National Health ServiceFoundation Trust, Manchester Academic Health Science Centre, United Kingdom(A.M., V.P., C.M., B.K.). , Michael PapadakisMichael Papadakis https://orcid.org/0000-0003-0616-2353 Cardiology Clinical Academic Group, St George's, University of London, United Kingdom(A.M., M.P., S.S.). and Sanjay SharmaSanjay Sharma https://orcid.org/0000-0002-3630-6138 Cardiology Clinical Academic Group, St George's, University of London, United Kingdom(A.M., M.P., S.S.). Originally published30 Dec 2020https://doi.org/10.1161/CIRCULATIONAHA.120.049740Circulation. 2021;143:94–96Contemporary data on exercise-related sudden cardiac death reveal that young adolescent athletes (14 to 18 years old) are the most vulnerable group.1 Several studies have described the adolescent athlete's heart but have focused only on White or Black athletes.2,3 The demographic landscape for adolescent athletes has changed over the past few decades and consists of an increasing population of mixed-race individuals in whom one parent is Black (African or Afro-Caribbean) and the other parent is White. We examined the electric and structural adaptations in the heart in healthy mixed-race male soccer players and compared them with those of White and Black male soccer players.Ethics approval was granted in accordance with the Research Governance Framework for Health and Social Care (2005) and the English Football Association. Written consent was obtained from all athletes in accordance with the Data Protection Act (approved in 1998). The data that support the findings of this study are available from the corresponding author on reasonable request.Between 2015 and 2018, 3000 consecutive cases of healthy mixed-race, Black, and White athletes were assessed with ECG and echocardiography. A mixed-race athlete was classified as an individual with 1 White parent of European origin and 1 Black parent of African/Afro-Caribbean origin.The 12-lead ECG was interpreted in accordance with international recommendations.4 Transthoracic echocardiography was performed in accordance with standard American and European protocols. The χ2 test was used to compare the prevalence of ECG and echocardiogram features among Black, White, and mixed-race groups.The mean age was 16.4±1.3 years. Among mixed-race athletes, 1 parent was White British in all cases; the other parent was either of African (60%) or Caribbean (40%) origin. Black athletes were of African (61%) or Caribbean (39%) origin.Electric ChangesSinus bradycardia and Sokolow-Lyon criterion for left ventricular (LV) hypertrophy were most prevalent among mixed-race athletes. Mixed-race and Black athletes demonstrated a similar prevalence of voltage criteria for left and right atrial enlargement, which was higher compared with White athletes.T-wave inversion (TWI) was most common in Black athletes, followed by mixed-race and White athletes (12.6%, 8.6%, and 2.3%, respectively). The prevalence of anterior TWI was higher in Black athletes (9.5%) than in mixed-race and White athletes (1.5%).Mixed-race and Black athletes had a similar prevalence of inferior TWI (2% versus 1.5%; P=0.49). This was higher in mixed-race than in White athletes (2% versus 0.5%; P=0.004) and in Black versus White athletes (1.5% versus 0.5%; P=0.04). Mixed-raced and Black athletes had a similar prevalence of lateral/apical TWI (0.6% versus 1.0%; P=0.33), which was also higher among Black athletes than among White athletes (1.0% versus 0.2%; P=0.02; Table). No arrhythmias were identified in any group.Table 1. Electrocardiographic and Echocardiographic Features of 3000 Male Adolescent Athletes, by EthnicityECG/echocardiogram featureWhite (n=1000), %Black (n= 1000), %Mixed (n=1000), %White vs Black, P valueWhite vs mixed race, P valueBlack vs mixed race, P valueSinus bradycardia <60 bpm45.446.5670.65<0.0001*<0.0001*Sinus arrhythmia37.336.835.50.850.430.58LV hypertrophy25.617.630<0.0001*0.03*<0.0001*RV hypertrophy2.34.23.00.02*0.40.19Left atrial enlargement15.94.7<0.0001*<0.0001*0.27Right atrial enlargement0.73.93.0<0.0001*0.0002*0.33TWI, all2.313.08.6<0.0001*<0.0001*0.0019*TWI, anterior V1, V20.95.83.7<0.0001*<0.0001*0.04*TWI, anterior beyond V20.63.72.0<0.0001*0.0089*0.03*TWI, inferior0.51.52.00.04*0.0039*0.49TWI, lateral/apical0.210.60.02*0.290.33TWI, inferolateral/apical0.10.90.20.02*10.06ST segment elevation48.463.654.7<0.0001*0.0055*<0.0001*Ascending convex28.838.032.7<0.0001*0.04*0.0150*Ascending concave16.221.819.80.0017*0.04*0.3Isoelectric3.23.32.010.120.09Depressed0.20.50.20.4510.45Left atrial diameter, mm32.9±5.232.8±4.732.6±4.40.650.160.33LVWT, mm9.15±1.310.1±1.49.8±1.41<0.0001*<0.0001*<0.0001*Relative wall thickness0.36±0.050.38±0.040.37±0.05<0.0001*<0.0001*<0.0001*LVEDd, mm52.4±3.950.6±451.1±4.03<0.0001*<0.0001*0.0054*LVEDdi, mm/m227.9±2.1226.6±2.1927.2±2.05<0.0001*<0.0001*<0.0001*LVM, g168±33171±35173±310.048*<0.0001*0.18LVMi, b/m288.1±16.589.6±17.591.2±16.50.04*<0.0001*0.03*LV E/A2.10±0.62.02±0.52.05±0.50.0012*0.04*0.18RVD1, mm36.58±4.7636.35±4.8036.45±4.110.280.510.62Aortic root, mm27.56±3.2227.93±3.1627.90±3.810.01*0.03*0.85E/A indicates early filling velocity/atrial filling velocity; LV, left ventricular; LVEDd, left ventricular end diastolic diameter; LVEDdi, left ventricular end diastolic dimension index; LVM, left ventricular mass; LVMi, left ventricular mass indexed to body surface area; LVWT, left ventricular wall thickness; RV, right ventricular; RVD1, right ventricular diameter at level of tricuspid valve; and TWI, T-wave inversion.* Statistically significant (P 12 mm was present in 7.1% of Black athletes, 5.9% of mixed-race athletes, and 1.3% of White athletes. The maximal LV wall thickness did not exceed 15 mm in any athlete.White athletes demonstrated the largest LV cavity size and mixed-race athletes had larger LV cavities than Black athletes. These differences became more pronounced when indexed for body surface area. A total of 5.9% of White athletes demonstrated an LV end diastolic dimension >58 mm, as did 4.4% of mixed-race athletes and 3.2% of Black athletes. None of the athletes showed an LV end diastolic dimension >62 mm.Among athletes with an abnormal ECG (mixed-race interpretation as in White athletes), a LV wall thickness >12 mm, LV cavity >60 mm, or LV ejection fraction 13 mm. On the basis of our observations, anterior TWI and a marginally increased LV wall thickness may be normal adaptation to athletic training in mixed-race athletes.The study included only elite male soccer players, but soccer involves a combination of strength and endurance exercises and is the most popular sport worldwide. The cross-sectional nature of the study precludes comment on the longitudinal implications of repolarization changes, mild LV hypertrophy, or LV dilation with reference to development of cardiomyopathy in the future.AcknowledgmentsThe authors thank The Football Association Cardiology Consensus panel and Cardiac Risk in the Young charity for support. Dr Miller is supported by the National Institute of Health and Research. Professor Bernard Keavney is supported by the British Heart Foundation.DisclosuresNone.Footnoteshttps://www.ahajournals.org/journal/circAneil Malhotra, St George's, University of London, Cranmer Terrace, London, United Kingdom SW17 0RE. Email [email protected]ac.ukReferences1. Malhotra A, Dhutia H, Finocchiaro G, Gati S, Beasley I, Clift P, Cowie C, Kenny A, Mayet J, Oxborough D, et al.. Outcomes of cardiac screening in adolescent soccer players.N Engl J Med. 2018; 379:524–534. doi: 10.1056/NEJMoa1714719CrossrefMedlineGoogle Scholar2. Papadakis M, Carre F, Kervio G, Rawlins J, Panoulas VF, Chandra N, Basavarajaiah S, Carby L, Fonseca T, Sharma S. The prevalence, distribution, and clinical outcomes of electrocardiographic repolarization patterns in male athletes of African/Afro-Caribbean origin.Eur Heart J. 2011; 32:2304–2313. doi: 10.1093/eurheartj/ehr140CrossrefMedlineGoogle Scholar3. Sheikh N, Papadakis M, Carre F, Kervio G, Panoulas VF, Ghani S, Zaidi A, Gati S, Rawlins J, Wilson MG, et al.. Cardiac adaptation to exercise in adolescent athletes of African ethnicity: an emergent elite athletic population.Br J Sports Med. 2013; 47:585–592. doi: 10.1136/bjsports-2012-091874CrossrefMedlineGoogle Scholar4. Sharma S, Drezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, La Gerche A, Ackerman MJ, Borjesson M, Salerno JC, et al.. International recommendations for electrocardiographic interpretation in athletes.Eur Heart J. 2018; 39:1466–1480. doi: 10.1093/eurheartj/ehw631CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Tso J, Turner C, Liu C, Galante A, Gilson C, Clark C, Taylor H, Quyyumi A, Baggish A and Kim J (2021) Association between race and maladaptive concentric left ventricular hypertrophy in American-style football athletes, British Journal of Sports Medicine, 10.1136/bjsports-2021-104333, 56:3, (151-157), Online publication date: 1-Feb-2022. Husaini M, Dineen E and Prutkin J (2021) Representation matters: The importance of obtaining diverse ECG normative data from non-Caucasian athletes, Journal of Electrocardiology, 10.1016/j.jelectrocard.2021.07.006, 68, (46-47), Online publication date: 1-Sep-2021. Davis A, Semsarian C, Orchard J, La Gerche A and Orchard J (2022) The Impact of Ethnicity on Athlete ECG Interpretation: A Systematic Review, Journal of Cardiovascular Development and Disease, 10.3390/jcdd9060183, 9:6, (183) Cavarretta E, Sciarra L, Biondi-Zoccai G, Maffessanti F, Nigro A, Sperandii F, Guerra E, Quaranta F, Fossati C, Peruzzi M, Pingitore A, Stasinopoulos D, Rigby R, Adorisio R, Saglietto A, Calò L, Frati G and Pigozzi F (2022) Age-Related Electrocardiographic Characteristics of Male Junior Soccer Athletes, Frontiers in Cardiovascular Medicine, 10.3389/fcvm.2021.784170, 8 January 5, 2021Vol 143, Issue 1Article InformationMetrics © 2020 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.120.049740PMID: 33378235 Originally publishedDecember 30, 2020 Keywordselectrocardiographyathletesphysiological adaptationPDF download Advertisement SubjectsEchocardiographyElectrocardiology (ECG)ExerciseRace and Ethnicity
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