January 10, 2008–ROME–An abnormal electrocardiogram (ECG) in a young, highly-trained athlete might be the first expression of an underlying heart condition that could later become life threatening, according to a study published in today’s New England Journal of Medicine. This means that athletes with abnormal ECGs should be checked regularly, according to investigators.
“Contrary to previous reports describing such ECG patterns as innocent manifestations of ‘athlete's heart,’ without adverse clinical consequences, the present study shows that these abnormal ECGs may represent the initial expression of genetic cardiac disease… and adverse clinical outcomes," according to lead investigator Dr Antonio Pelliccia (Institute of Sports Medicine and Science, Rome, Italy) and colleagues.
The Italian authors, along with Dr Barry Maron (Minneapolis Heart Institute Foundation, MN), note that 12-lead ECGs often show a range of alterations in young, trained athletes, most commonly of the type suggesting left ventricular hypertrophy (an enlarged heart). Such abnormalities are usually attributed to exercise training, but for a small subgroup of athletes there could be an underlying cardiac disorder.
Italy is one of the few countries to legally require those participating in competitive sports to undergo pre-participation ECG screening to rule out cardiovascular disease. Because of this, Pelliccia and colleagues were able to evaluate the clinical outcomes associated with abnormal ECGs in trained athletes. From the database of more than 12,000 athletes, the group identified 81 athletes with abnormalities but no apparent cardiac disease. Of the 81 athletes with abnormal ECGs, five later proved to have cardiomyopathy (disease of the heart muscle), including one who died at age 24.
“These observations underscore the importance of greater diagnostic scrutiny and continued clinical surveillance of trained athletes who present with such distinctly abnormal ECGs,” write the authors. A series of ECGs alone are not sufficient, however. Rather, the authors say, echocardiography and selected additional testing are necessary to clarify the cardiac diagnosis.
“Conversely,” they add, “the finding of a normal ECG during pre-participation screening… can serve as a source of reassurance to young athletes,” according to the authors.
Pelliccia A, Di Paolo FM, Quattrini FM, et al. Outcomes in athletes with marked ECG repolarization abnormalities. N Engl J Med 2008; 358:152-61.