Division of Cardiovascular Sciences, St George's University of London (SGUL), Cranmer Terrace, SW17 0RE London, UK.
Eur Heart J. 2013 Dec;34(47):3649-56. doi: 10.1093/eurheartj/eht391. Epub 2013 Sep 17.
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.
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.
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.
对年轻运动员进行赛前心血管筛查可能会预防与运动相关的心脏性猝死。识别健康运动员的生理性心电图（ECG）变化提高了筛查的特异性，同时保持了对疾病的敏感性。本研究的目的是确定心电图右心室肥厚（RVH）在运动员中的临床意义。
在 2010 年至 2012 年间，对 868 名年龄在 14-35 岁（68.8%为男性）的受试者进行了心电图和超声心动图检查（运动员 627 例，久坐对照组 241 例）。将结果与已确诊的右心室（RV）病变患者（致心律失常性右心室心肌病，n=68；肺动脉高压，n=30）进行比较。与对照组相比，运动员的 Sokolow-Lyon RVH（R[V1]+S[V5 或 V6]＞1.05 mV）更为常见（11.8%比 6.2%，P=0.017），但 RV 壁厚度（RVWT）相似（4.0±1.0 毫米比 3.9±0.9 毫米，P=0.18）。表现出心电图 RVH 的运动员主要为男性（95.9%），并且与心电图正常的运动员具有相似的 RV 大小和功能（RVWT；4.0±1.1 毫米比 4.0±0.9 毫米，P=0.95，RV 基底直径；42.7±5.2 毫米比 42.1±5.9 毫米，P=0.43，RV 分数面积变化；40.6±7.6%比 42.2±8.1%，P=0.14）。Sokolow-Lyon RVH 对超声心动图 RVH（＞5 毫米）的敏感性和特异性分别为 14.3%和 88.2%。进一步的评估，包括心脏磁共振成像，没有诊断出任何运动员的右心室病理学。没有一个心肌病或肺动脉高压患者在没有其他心电图异常的情况下表现出电压 RVH。
在没有潜在 RV 病理学的健康运动员中，心电图电压标准常可满足 RVH 的要求，如果孤立观察，不应进一步评估。认识到这一现象应减少赛前心电图筛查后的检查负担，而不会降低对疾病的敏感性。
