Comparison of athletes with life-threatening ventricular arrhythmias with two groups of healthy athletes and a group of normal control subjects

doi:10.1016/0002-9149(94)90464-2

The American Journal of Cardiology

Volume 74, Issue 11, 1 December 1994, Pages 1124-1128

https://doi.org/10.1016/0002-9149(94)90464-2 Get rights and content

Abstract

Sudden cardiac death in well-trained athletes is most often superimposed on the presence of structural heart disease. However, some athletes die suddenly in the absence of overt heart disease. To improve identification of athletes at high risk for ventricular tachycardia (VT), ventricular repolarization, the signal-averaged electrocardiogram (ECG), and the echocardiogram from 13 male athletes with symptomatic VT and without evidence of manifest cardiac disease were compared with data obtained in 3 matched control groups (15 apparently healthy professional road cyclists, 10 professional basketball players, and 15 normal control subjects without any sports activity). All patients had apparently normal QRS duration on the routine ECG, and none were taking antiarrhythmic drugs. Echocardiography and signal-averaged electrocardiography were useful in distinguishing the group of athletes with tachyarrhythmias from the group of normal nonsporting controls, but not from both groups of normal athletes. The QT interval (V₄) and the QT interval corrected with the cubic root were shorter for the nonsporting controls. Three parameters for QT dispersion showed significant differences (p < 0.003) between athletes with disease and all other groups. It is concluded that although significant differences were detected between normal subjects and the 3 groups of athletes by routine ECG, the signal-averaged ECG, and echocardiography, only an increased QT dispersion from the 12-lead ECG was helpful in distinguishing athletes with VT from other athletes.

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Cited by (44)

Impact of endurance exercise on the heart of cyclists: A systematic review and meta-analysis
2020, Progress in Cardiovascular Diseases
Citation Excerpt :
For dichotomous variables (cardiac abnormality outcomes), odds ratio (OR) with 95% CI were calculated.46 From the 4865 unique studies identified during the literature search, 70 studies met the inclusion criteria for review (Fig. 1) and data were extracted from 25 studies28,38,47–69 for analysis (Table 1). Of these, 18 studies28,38,48,49,52–54,56–66 compared cyclists to control and 10 studies28,47–55 compared cyclists to athletes participating in other sports, with cardiac outcomes reported in units relative to body size for meta-analysis.
To compare heart structure and function in endurance athletes relative to participants of other sports and non-athletic controls in units relative to body size. A secondary objective was to assess the association between endurance cycling and cardiac abnormalities.
Five electronic databases (CINAHL, Cochrane Library, Medline, Scopus, and SPORTdiscus) were searched from the earliest record to 14 December 2019 to identify studies investigating cardiovascular structure and function in cyclists. Of the 4865 unique articles identified, 70 met inclusion criteria and of these, 22 articles presented 10 cardiovascular parameters in units relative to body size for meta-analysis and five presented data relating to incidence of cardiac abnormalities. Qualitative analysis was performed on remaining data. The overall quality of evidence was assessed using GRADE. Odds ratios were calculated to compare the incidence of cardiac abnormality.
Heart structure was significantly larger in cyclists compared to non-athletic controls for left ventricular: mass; end-diastolic volume, interventricular septal diameter and internal diameter; posterior wall thickness, and end-systolic internal diameter. Compared to high static and high dynamic sports (e.g., kayaking and canoeing), low-to-moderate static and moderate-to-high dynamic sports (e.g., running and swimming) and moderate-to-high static and low-to-moderate dynamic sports (e.g., bodybuilding and wrestling), endurance cyclists end-diastolic left ventricular internal diameter was consistently larger (mean difference 1.2–3.2 mm/m²). Cardiac abnormalities were higher in cyclists compared to controls (odds ratio: 1.5, 95%CI 1.2–1.8), but the types of cardiac abnormalities in cyclists were not different to other athletes.
Endurance cycling is associated with a larger heart relative to body size and an increased incidence of cardiac abnormalities relative to controls.
Effect of aerobic conditioning on ventricular activation: A principal components analysis approach to high-resolution electrocardiogram
2013, Computers in Biology and Medicine
Citation Excerpt :
The athlete's heart is a reversible structural and functional adaptation of the myocardial tissue, developed through regular physical training. Despite a physiological reduction in heart rate, aerobic physical conditioning has shown negligible effects on the duration of ventricular activation [14]. Jordaens et al. (1994) did not find significant differences between the QRS durations of four different groups: 13 male athletes with symptomatic ventricular tachycardia without evidence of cardiac disease were compared with three matched control groups (15 professional cyclists, 10 professional basketball players and 15 normal control subjects without any sports activity) [14].
The athlete's heart represents a reversible structural and functional adaptations of myocardial tissue developed through physical conditioning. Surface electrocardiogram (ECG) has the capability to detect myocardial hypertrophy but has limited performance in monitoring physical conditioning-induced myocardial remodeling. The aim of this study was to develop an ECG-derived test for detecting incipient myocardial hypertrophy in well-conditioned athletes based on a principal components (PC) analysis.
Two groups of study composed of 14 sedentary healthy volunteers (Control group) and 14 professional long distance runners (Athlete group) had their maximal metabolic equivalents (MET) estimated (mean±SD: Control group: 9±2 METs vs. Athlete group: 20±1 METs, p<0.05). All participants had their high-resolution ECG (HRECG) recorded, and a 120 ms segment starting at the QRS complex onset and ending in the ST segment was extracted to build a data matrix for PC analysis. The Mahalanobis distance was evaluated by a logistic regression model to determine the optimal separation threshold between groups. HRECG was also analyzed using the classical time domain approach. The comparison of areas under the receiver operating characteristic curve (c-statistic) in 10,000 bootstrap re-samplings measured how well each method detected physical conditioning (α<0.05).
Average bootstrap c-statistic for PC analysis and time domain approaches were 0.98 and 0.79 (p<0.05), respectively. PC analysis and maximal oxygen consumption exhibited comparable performances to distinguish between groups.
The PC analysis method applied to HRECG signals appropriately discriminates well-conditioned athletes from healthy, sedentary subjects.
Antagonist: Routine screening of all athletes prior to participation in competitive sports should be mandatory to prevent sudden cardiac death
2007, Heart Rhythm
QT interval and mortality from coronary artery disease
2000, Progress in Cardiovascular Diseases
Abnormalities in the QT interval can be divided into 3 types, prolongation of the QT interval, increases in the dispersion of the QT interval, and abnormalities in the heart rate dependent behavior of the QT interval. Abnormalities may be found in short or long-term recordings. Prolongation of the QT interval may reflect factors associated with an adverse prognosis in coronary disease and may in itself be arrhythmogenic. The data to date suggest that there is an association between adverse prognosis and QT interval prolongation in coronary disease, both before and after acute myocardial infarctions. This relationship is weak, however, and is not clinically useful. The data as to whether increased QT dispersion postmyocardial infarction relates to adverse prognosis is weak because there is no convincing evidence yet. If there is a relationship it is weak. Abnormalities in the rate dependent behavior of the QT interval are widely found, but as no large scale prospective study with mortality as an endpoint has yet been undertaken the significance of rate dependent abnormalities is uncertain. The widespread introduction of beat-to-beat QT analysis of 24 hour Holter tapes may take QT intervalology into the realm of clinical practice. Copyright © 2000 by W.B. Saunders Company
Progress in Cardiovascular Diseases, Vol. 42, No. 5 (March/April), 2000: pp 359-384
Estimates of repolarization and its dispersion from electrocardiographic measurements: Direct epicardial assessment in the canine heart
2000, Journal of Electrocardiology
This study investigates a technique to estimate dispersion based on the root mean square (RMS) signal of multiple electrocardiographic leads. Activation and recovery times were measured from 64 sites on the epicardium of canine hearts using acute in situ or Langendorff perfused isolated heart preparations. Repolarization and its dispersion were altered by varying cycle length, myocardial temperature, or ventricular pacing site. Mean and dispersion of activation and recovery times, and activation-recovery interval (ARI) were calculated for each beat. The waveform was then calculated from all leads. Estimates of mean and dispersion of activation and recovery times and mean ARI were derived using only inflection points from the RMS waveform. QT intervals were also measured and QT dispersion was determined. Estimates determined from the RMS waveform provided accurate estimates of repolarization and were, in particular, a better measure of repolarization dispersion than QT dispersion.
QT dispersion in athletic left ventricular hypertrophy
1999, American Heart Journal
Objective To assess whether physiologic left ventricular hypertrophy as a result of physical training is associated with an increased QT length or dispersion. Methods Thirty-three subjects were assessed. These consisted of a group of international endurance athletes (including 8 rowers, 2 cyclists, and 1 triathlete), a group of 12 professional soccer players, and a further group of 10 control subjects. Each underwent 2-dimensional echocardiography and 12-lead electrocardiographic examination. Results Left ventricular mass index was considerably greater in both the endurance athlete (163.3 ± 14.4 g/m²; P < .01) and soccer player groups (144.2 ± 5.5 g/m ²; P < .05) compared with the controls (109.2 ± 6.3 g/m²). In spite of these large differences in cardiac structure there were no significant differences in QT parameters between the groups (QT dispersion 56.9 ± 5.5, 68.5 ± 9.5, and 67.2 ± 12.6 ms; QTc dispersion 61.4 ± 9.2, 69.4 ± 13.3, and 54.2 ± 6.5 ms; maximum QT 402 ± 10.3, 404 ± 9.6, and 392 ± 14.0 ms; and maximum QTc 404 ± 7.0, 413 ± 9.3, and 399 ± 9.9 ms among endurance athletes, soccer players, and controls, respectively). Conclusion Left ventricular hypertrophy occurring as a consequence of athletic training does not appear to be associated with a major increase in QT length or QT dispersion. (Am Heart J 1999;137:678-81.)

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Comparison of athletes with life-threatening ventricular arrhythmias with two groups of healthy athletes and a group of normal control subjects

Abstract

J Am Coll Cardiol

Am Heart J

J Electrocardiol

J Am Coll Cardiol

J Am Coll Cardiol

Lancet

Chest

Int J Cardiol

Am Heart J

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

Am Heart J

Sudden death and vigorous exercise—a study of 60 deaths associated with squash

Br Heart J

Exercise and sudden death

Br J Sports Med