PDF herunterladen
Int J Sports Med 2014; 35(03): 253-258
DOI: 10.1055/s-0033-1345180
Clinical Sciences
© Georg Thieme Verlag KG Stuttgart · New York

Adult ECG Criteria for Left Ventricular Hypertrophy in Young Competitive Athletes

G. Speranza
1   Department of Biomorphology, Post-Graduate School of Sports Medicine, University of Messina, Italy
,
L. Magaudda
1   Department of Biomorphology, Post-Graduate School of Sports Medicine, University of Messina, Italy
,
C. de Gregorio
1   Department of Biomorphology, Post-Graduate School of Sports Medicine, University of Messina, Italy
2   Department of Clinical and Experimental Medicine, University of Messina, Italy
› Institutsangaben
Weitere Informationen

Publikationsverlauf



accepted after revision 17. April 2013

Publikationsdatum:
30. Juli 2013 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Time-tested data indicate that ECG diagnosis of left ventricular hypertrophy in young athletes is challenging due to low sensitivity of the commonly used criteria. We sought to establish whether adult ECG criteria can be appropriate to make diagnosis of both common and uncommon patterns of left ventricular hypertrophy in young trained athletes. A total of 122 athletes, ages 16.2±3.8 years, training at least 5 h per week, were studied with Sokolow-Lyon voltage, Romhilt-Estes, Cornell voltage, Cornell Product, Perugia and Framingham scores. Garson Criteria were also investigated in athletes under 16. Participants were divided into 2 groups based on the presence (group-A, n=56) or absence (group-B, n=66) of at least one positive ECG score. Test performance was calculated with respect to accurate echocardiographic diagnosis of left ventricular hypertrophy. There were no inter-group differences regarding physical characteristics and training burden. 9 athletes from group-A (16%) and 2 from group-B (3%) were found to have left ventricular hypertrophy, likely to be pathological in 2 cases from group-A. Criteria gathering both QRS voltages and ST-T anomalies, like Perugia-score, best identified this subgroup and should be preferred to those based on QRS voltage analysis alone.

Key words

cardiac physiology - echocardiography - electrocardiography - hypertrophic cardiomyopathy - left ventricular hypertrophy - sports
 

  • References

  • 1 Blomquist CG, Saltin B. Cardiovascular adaptation to physical training. Ann Rev Physiol 1983; 45: 169-189
    CrossrefPubMedGoogle Scholar
  • 2 Casale PN, Devereux RB, Kligfield P, Eisenberg RR, Miller DH, Chaudhary BS, Phillips MC. Electrocardiographic detection of left ventricular hypertrophy: development and prospective validation of improved criteria. J Am Coll Cardiol 1985; 6: 572-580
    CrossrefPubMedGoogle Scholar
  • 3 Corrado D, Pelliccia A, Bjørnstad HH, Vanhees L, Biffi A, Borjesson M, Panhuyzen-Goedkoop N, Deligiannis A, Solberg E, Dugmore D, Mellwig KP, Assanelli D, Delise P, van-Buuren F, Anastasakis A, Heidbuchel H, Hoffmann E, Fagard R, Priori SG, Basso C, Arbustini E, Blomstrom-Lundqvist C, McKenna WJ, Thiene G. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Eur Heart J 2005; 26: 516-524
    CrossrefPubMedGoogle Scholar
  • 4 Corrado D, Pelliccia A, Heidbuchel H, Sharma S, Link M, Basso C, Biffi A, Buja G, Delise P, Gussac I, Anastasakis A, Borjesson M, Bjørnstad HH, Carrè F, Deligiannis A, Dugmore D, Fagard R, Hoogsteen J, Mellwig KP, Panhuyzen-Goedkoop N, Solberg E, Vanhees L, Drezner J, Estes 3rd NA, Iliceto S, Maron BJ, Peidro R, Schwartz PJ, Stein R, Thiene G, Zeppilli P, McKenna WJ. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J 2010; 31: 243-259
    CrossrefPubMedGoogle Scholar
  • 5 de Gregorio C. Preparticipation screening of young athletes: Why still open questions on performing an electrocardiogram?. J Clin Exp Cardiol 2012; 3: e117
    PubMedGoogle Scholar
  • 6 de Gregorio C, Magliarditi A, Magaudda L. Dramatic electrocardiographic changes in a junior athlete with unpredictable hypertrophic cardiomyopathy. Int J Cardiol 2009; 137: e51-e53
    CrossrefPubMedGoogle Scholar
  • 7 de Gregorio C, Speranza G, Zagari D, Caruso R. Solitary papillary muscle hypertrophy in young athletes: A rationale for inverted T waves on ECG?. J Cardiovasc Med 2013; (in press)
    PubMedGoogle Scholar
  • 8 Devereux RB, Reichek N. Repolarization abnormalities of left ventricular hypertrophy: clinical, echocardiographic and hemodynamic correlates. J Electrocardiol 1982; 15: 47-54
    CrossrefPubMedGoogle Scholar
  • 9 Fagard RH. Impact of different sports and training on cardiac structure and function. In: The athlete’s heart. Edited by Maron BJ. Philadelphia: Cardiol Clin; 1992: 241-256
    Google Scholar
  • 10 Garson AJ. Diagnostic electrocardiography. In: Anderson RH, Baker EJ, Makartney FJ, Rigby ML, Shinebourne EA, Tynan M. (eds.). Paediatric Cardiology. London: Churchill Livingstone; Ed, 2002: 295-378
    Google Scholar
  • 11 Harriss DJ, Atkinson G. Update – ethical standards in sport and exercise science research. Int J Sports Med 2011; 32: 819-821
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 12 Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer KT, St John Sutton M, Stewart W. Recommendations for chamber quantification. Eur J Echocardiogr 2006; 7: 79-108
    CrossrefPubMedGoogle Scholar
  • 13 Levy D, Labib SB, Anderson KM, Christiansen JC, Kannel WB, Castelli WP. Determinants of sensitivity and specificity of electrocardiographic criteria for left ventricular hypertrophy. Circulation 1990; 81: 815-820
    CrossrefPubMedGoogle Scholar
  • 14 Kobashi A, Suwa M, Ito T, Otake Y, Hirota Y, Kawamura K. Solitary papillary muscle hypertrophy as a possible form of hypertrophic cardiomyopathy. Jpn Circ J 1998; 62: 811-816
    CrossrefPubMedGoogle Scholar
  • 15 Maron BJ. Structural features of the athlete heart as defined by echocardiography. J Am Coll Cardiol 1986; 7: 190-203
    CrossrefPubMedGoogle Scholar
  • 16 Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D, Dimeff R, Douglas PS, Glover DW, Hutter Jr AM, Krauss MD, Maron MS, Mitten MJ, Roberts WO, Puffer JC. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update a scientific statement from the American Heart Association Council on Nutrition. Physical Activity, and Metabolism. Circulation 2007; 115: 1643-1655
    PubMedGoogle Scholar
  • 17 Migliore F, Zorzi A, Michieli P, Perazzolo Marra M, Siciliano M, Rigato I, Bauce B, Basso C, Toazza D, Schiavon M, Iliceto S, Thiene G, Corrado D. Prevalence of cardiomyopathy in Italian asymptomatic children with electrocardiographic T-wave inversion at preparticipation screening. Circulation 2012; 125: 529-538
    CrossrefPubMedGoogle Scholar
  • 18 Molloy TJ, Okin PM, Devereux RB, Kligfield P. Electrocardiographic detection of left ventricular hypertrophy by the simple QRS voltage-duration product. J Am Coll Cardiol 1992; 20: 1180-1186
    CrossrefPubMedGoogle Scholar
  • 19 Overbeek LI, Kapusta L, Peer PG, de Korte CL, Thijssen JM, Daniels O. New reference values for echocardiographic dimensions of healthy Dutch children. Eur J Echocardiogr 2006; 7: 113-121
    CrossrefPubMedGoogle Scholar
  • 20 Pelliccia A, Di Paolo FM, Corrado D, Buccolieri C, Quattrini FM, Pisicchio C, Spataro A, Biffi A, Granata M, Maron BJ. Evidence for efficacy of the Italian national pre-participation screening programme for identification of hypertrophic cardiomyopathy in competitive athletes. Eur Heart J 2006; 27: 2196-2200
    CrossrefPubMedGoogle Scholar
  • 21 Pelliccia A, Maron BJ, Culasso F, Di Paolo FM, Spataro A, Biffi A, Caselli G, Piovano P. Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation 2000; 102: 278-284
    CrossrefPubMedGoogle Scholar
  • 22 Pelliccia A, Maron BJ, Spataro A, Proschan MA, Spirito P. The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med 1991; 324: 295-301
    CrossrefPubMedGoogle Scholar
  • 23 Pluim BM, Zwinderman AH, van der Laarse A, van der Wall EE. The athlete’s heart: a meta-analysis of cardiac structure and function. Circulation 2000; 101: 336-344
    CrossrefPubMedGoogle Scholar
  • 24 Rijnbeek PR, van Herpen G, Kapusta L, ten Harkel ADJ, Witsenburg M, Kors JA. Electrocardiographic criteria for left ventricular hypertrophy in children. Pediatr Cardiol 2008; 29: 923-928
    CrossrefPubMedGoogle Scholar
  • 25 Rijnbeek PR, Witsenburg M, Schrama E, Hess J, Kors JA. New normal limits for the paediatric electrocardiogram. Eur Heart J 2001; 22: 702-711
    CrossrefPubMedGoogle Scholar
  • 26 Romhilt DW, Estes Jr EH. A point-score system for the ECG diagnosis of left ventricular hypertrophy. Am Heart J 1968; 75: 752-758
    CrossrefPubMedGoogle Scholar
  • 27 Sharma S, Maron BJ, Whyte G, Firoozi S, Elliott PM, McKenna WJ. Physiologic limits of left ventricular hypertrophy in elite junior athletes: Relevance to differential diagnosis of athlete’s heart and hypertrophic cardiomyopathy. J Am Coll Cardiol 2002; 40: 1431-1436
    CrossrefPubMedGoogle Scholar
  • 28 Sharma S, Whyte G, Elliott P, Padula M, Kaushal R, Mahon N, McKenna WJ. Electrocardiographic changes in 1000 highly trained junior elite athletes. Br J Sports Med 1999; 33: 319-324
    CrossrefPubMedGoogle Scholar
  • 29 Sokolow M, Lyon TP. The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J 1949; 37: 161-186
    CrossrefPubMedGoogle Scholar
  • 30 Spirito P, Pelliccia A, Proschan M, Granata M, Spataro A, Bellone P, Caselli G, Biffi A, Vecchio C, Maron BJ. Morphology of the “athlete’s heart” assessed by echocardiography in 947 elite athletes representing 27 sports. Am J Cardiol 1994; 74: 802-806
    CrossrefPubMedGoogle Scholar
  • 31 Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Gattobigio R, Zampi I, Porcellati C. Prognostic value of a new electrocardiographic method for diagnosis of left ventricular hypertrophy in essential hypertension. J Am Coll Cardiol 1998; 31: 383-390
    PubMedGoogle Scholar