Clinical significance of electrocardiographic right ventricular hypertrophy in athletes: comparison with arrhythmogenic right ventricular cardiomyopathy and pulmonary hypertension.

Abstract

AIMS:

Pre-participation cardiovascular screening of young athletes may prevent sports-related sudden cardiac deaths. Recognition of physiological electrocardiography (ECG) changes in healthy athletes has improved the specificity of screening while maintaining sensitivity for disease. The study objective was to determine the clinical significance of electrocardiographic right ventricular hypertrophy (RVH) in athletes.

METHODS AND RESULTS:

Between 2010 and 2012, 868 subjects aged 14-35 years (68.8% male) were assessed using ECG and echocardiography (athletes; n = 627, sedentary controls; n = 241). Results were compared against patients with established right ventricular (RV) pathology (arrhythmogenic right ventricular cardiomyopathy, n = 68; pulmonary hypertension, n = 30). Sokolow-Lyon RVH (R[V1]+S[V5orV6] > 1.05 mV) was more prevalent in athletes than controls (11.8 vs. 6.2%, P = 0.017), although RV wall thickness (RVWT) was similar (4.0 ± 1.0 vs. 3.9 ± 0.9 mm, P = 0.18). Athletes exhibiting electrocardiographic RVH were predominantly male (95.9%), and demonstrated similar RV dimensions and function to athletes with normal electrocardiograms (RVWT; 4.0 ± 1.1 vs. 4.0 ± 0.9 mm, P = 0.95, RV basal dimension; 42.7 ± 5.2 vs. 42.1 ± 5.9 mm, P = 0.43, RV fractional area change; 40.6 ± 7.6 vs. 42.2 ± 8.1%, P = 0.14). Sensitivity and specificity of Sokolow-Lyon RVH for echocardiographic RVH (>5 mm) were 14.3 and 88.2%, respectively. Further evaluation including cardiac magnetic resonance imaging did not diagnose right ventricular pathology in any athlete. None of the cardiomyopathic or pulmonary hypertensive patients exhibited voltage RVH without additional ECG abnormalities.

CONCLUSION:

Electrocardiographic voltage criteria for RVH are frequently fulfilled in healthy athletes without underlying RV pathology, and should not prompt further evaluation if observed in isolation. Recognition of this phenomenon should reduce the burden of investigations after pre-participation ECG screening without compromising sensitivity for disease.

• Authors: Abbas Zaidi, Saqib Ghani, Nabeel Sheikh, Sabiha Gati, Rachel Bastiaenen, Brendan Madden, Michael Papadakis, Hariharan Raju, Matthew Reed, Rajan Sharma, Elijah R Behr, Sanjay Sharma
• Journal: European heart journal (Eur Heart J) Vol. 34 Issue 47 Pg. 3649-56 (Dec 2013) ISSN: 1522-9645 [Electronic] England
• PMID: 24046435 (Publication Type: Comparative Study, Journal Article, Observational Study, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Arrhythmogenic Right Ventricular Dysplasia (diagnosis)
• Case-Control Studies
• Early Diagnosis
• Electrocardiography (methods)
• Female
• Humans
• Hypertension, Pulmonary (diagnosis)
• Hypertrophy, Right Ventricular (diagnosis)
• Male
• Referral and Consultation
• Risk Factors
• Sports (physiology)
• Young Adult