Thomas Jason A, A Perez-Alday Erick, Junell Allison, Newton Kelley, Hamilton Christopher, Li-Pershing Yin, German David, Bender Aron, Tereshchenko Larisa G
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington.
Ann Noninvasive Electrocardiol. 2019 May;24(3):e12614. doi: 10.1111/anec.12614. Epub 2018 Nov 7.
Global electrical heterogeneity (GEH) is associated with sudden cardiac death (SCD) in adults of 45 years and above. However, GEH has not been previously measured in young athletes. The goal of this study was to establish a reference for vectorcardiograpic (VCG) metrics in male and female athletes.
Skiers (n = 140; mean age 19.2 ± 3.5 years; 66% male, 94% white; 53% professional athletes) were enrolled in a prospective cohort. Resting 12-lead ECGs were interpreted per the International ECG criteria. Associations of age, sex, and athletic performance with GEH were studied.
In age and training level-adjusted analyses, male sex was associated with a larger T vector [T peak magnitude +186 (95% CI 106-266) µV] and a wider spatial QRS-T angle [+28.2 (17.3-39.2)°] as compared to women. Spatial QRS-T angle in the ECG left ventricular hypertrophy (LVH) voltage group (n = 21; 15%) and normal ECG group did not differ (67.7 ± 25.0 vs. 66.8 ± 28.2; p = 0.914), suggesting that ECG LVH voltage in athletes reflects physiological remodeling. In contrast, skiers with right ventricular hypertrophy (RVH) voltage (n = 26, 18.6%) had wider QRS-T angle (92.7 ± 29.6 vs. 66.8 ± 28.2°; p = 0.001), larger SAI QRST (194.9 ± 30.2 vs. 157.8 ± 42.6 mV × ms; p < 0.0001), but similar peak SVG vector magnitude (1976 ± 548 vs. 1939 ± 395 µV; p = 0.775) as compared to the normal ECG group. Better athletic performance was associated with the narrower QRS-T angle. Each 10% worsening in an athlete's Federation Internationale de' Ski downhill ranking percentile was associated with an increase in spatial QRS-T angle by 2.1 (95% CI 0.3-3.9) degrees (p = 0.013).
Vectorcardiograpic adds nuances to ECG phenomena in athletes.
整体电不均一性（GEH）与45岁及以上成年人的心源性猝死（SCD）相关。然而，此前尚未在年轻运动员中测量过GEH。本研究的目的是建立男女运动员心电图向量图（VCG）指标的参考标准。
前瞻性队列纳入了滑雪运动员（n = 140；平均年龄19.2±3.5岁；66%为男性，94%为白人；53%为职业运动员）。根据国际心电图标准解读静息12导联心电图。研究年龄、性别和运动表现与GEH的关联。
在年龄和训练水平校正分析中，与女性相比，男性的T向量更大[T峰幅度+186（95%CI 106 - 266）µV]，空间QRS - T角更宽[+28.2（17.3 - 39.2）°]。心电图左心室肥厚（LVH）电压组（n = 21；15%）和正常心电图组的空间QRS - T角无差异（67.7±25.0 vs. 66.8±28.2；p = 0.914），这表明运动员的心电图LVH电压反映了生理性重塑。相比之下，右心室肥厚（RVH）电压的滑雪运动员（n = 26，18.6%）的QRS - T角更宽（92.7±29.6 vs. 66.8±28.2°；p = 0.001），SAI QRST更大（194.9±30.2 vs. 157.8±42.6 mV×ms；p < 0.0001），但与正常心电图组相比，其SVG向量峰值幅度相似（1976±548 vs. 1939±395 µV；p = 0.775）。更好的运动表现与更窄的QRS - T角相关。运动员国际滑雪联合会速降排名百分位每恶化10%，空间QRS - T角增加2.1（95%CI 0.3 - 3.9）度（p = 0.013）。
心电图向量图为运动员的心电图现象增添了细微差别。
