Park Jihyun, Kimata Chieko, Young Justin, Perry James C, Bratincsak Andras
Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA, USA.
Department of Pediatrics, John A Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
Sports Med Open. 2024 Oct 23;10(1):114. doi: 10.1186/s40798-024-00775-9.
Electrocardiograms (ECGs) in athletes commonly reveal findings related to physiologic adaptations to exercise, that may be difficult to discern from true underlying cardiovascular abnormalities. North American and European societies have published consensus statements for normal, borderline, and abnormal ECG findings for athletes, but these criteria are not based on established correlation with disease states. Additionally, data comparing ECG findings in athletes to non-athlete control subjects are lacking. Our objective was to compare the ECGs of collegiate athletes and non-athlete controls using Z-scores for digital ECG variables to better identify significant differences between the groups and to evaluate the ECG variables in athletes falling outside the normal range.
Values for 102 digital ECG variables on 7206 subjects aged 17-22 years, including 672 athletes, from Hawaii Pacific Health, University of Hawaii, and Rady Children's Hospital San Diego were obtained through retrospective review. Age and sex-specific Z-scores for ECG variables were derived from normal subjects and used to assess the range of values for specific ECG variables in young athletes. Athletes with abnormal ECGs were referred to cardiology consultation and/or echocardiogram.
Athletes had slower heart rate, longer PR interval, more rightward QRS axis, longer QRS duration but shorter QTc duration, larger amplitude and area of T waves, prevalent R' waves in V1, and higher values of variables traditionally associated with left ventricular hypertrophy (LVH): amplitudes of S waves (leads V1-V2), Q waves (V6, III) and R waves (II, V5, V6). Z-scores of these ECG variables in 558 (83%) of the athletes fell within - 2.5 and 2.5 range derived from the normal population dataset, and 60 (8.9%) athletes had a Z-score outside the - 3 to 3 range. While 191 (28.4%) athletes met traditional voltage criteria for diagnosis of LVH on ECG, only 53 athletes (7.9%) had Z-scores outside the range of -2.5 to 2.5 for both S amplitude in leads V1-V2 and R amplitude in leads V5-6. Only one athlete was diagnosed with hypertrophic cardiomyopathy with a Z-score of R wave in V6 of 2.34 and T wave in V6 of -5.94.
The use of Z-scores derived from a normal population may provide more precise screening to define cardiac abnormalities in young athletes and reduce unnecessary secondary testing, restrictions and concern.
运动员的心电图（ECG）通常显示出与运动生理适应相关的结果，这可能难以与真正潜在的心血管异常相区分。北美和欧洲的学会已经发布了关于运动员正常、临界和异常心电图结果的共识声明，但这些标准并非基于与疾病状态的确立相关性。此外，缺乏将运动员的心电图结果与非运动员对照受试者进行比较的数据。我们的目的是使用数字心电图变量的Z分数比较大学生运动员和非运动员对照的心电图，以更好地识别两组之间的显著差异，并评估超出正常范围的运动员的心电图变量。
通过回顾性审查，获取了来自夏威夷太平洋健康中心、夏威夷大学和圣地亚哥拉迪儿童医院的7206名17 - 22岁受试者（包括672名运动员）的102个数字心电图变量的值。心电图变量的年龄和性别特异性Z分数来自正常受试者，并用于评估年轻运动员特定心电图变量的值范围。心电图异常的运动员被转诊至心脏科咨询和/或进行超声心动图检查。
运动员的心率较慢，PR间期较长，QRS轴更偏右，QRS时限较长但QTc时限较短，T波振幅和面积较大，V1导联普遍有R'波，以及传统上与左心室肥厚（LVH）相关的变量值较高：S波振幅（V1 - V2导联）、Q波（V6、III导联）和R波（II、V5、V6导联）。这些心电图变量的Z分数在558名（83%）运动员中落在从正常人群数据集中得出的 - 2.5至2.5范围内，60名（8.9%）运动员的Z分数在 - 3至3范围之外。虽然191名（28.4%）运动员符合心电图诊断LVH的传统电压标准，但只有53名运动员（7.9%）在V1 - V2导联的S振幅和V5 - 6导联的R振幅方面Z分数超出 - 2.5至2.5范围。只有一名运动员被诊断为肥厚型心肌病，其V6导联R波的Z分数为2.34，V6导联T波的Z分数为 - 5.94。
使用来自正常人群的Z分数可能提供更精确的筛查，以定义年轻运动员的心脏异常，并减少不必要的二次检查、限制和担忧。
