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Background Young, trained athletes may have abnormal 12-lead electrocardiograms (ECGs) without evidence of structural cardiac disease. Whether such ECG patterns represent the initial expression of underlying cardiac disease with potential long-term adverse consequences remains unresolved. We assessed long-term clinical outcomes in athletes with ECGs characterized by marked repolarization abnormalities.
Methods From a database of 12,550 trained athletes, we identified 81 with diffusely distributed and deeply inverted T waves (
Results Of the 81 athletes with abnormal ECGs, 5 (6%) ultimately proved to have cardiomyopathies, including one who died suddenly at the age of 24 years from clinically undetected arrhythmogenic right ventricular cardiomyopathy. Of the 80 surviving athletes, clinical and phenotypic features of hypertrophic cardiomyopathy developed in 3 after 12±5 years (at the ages of 27, 32, and 50 years), including 1 who had an aborted cardiac arrest. The fifth athlete demonstrated dilated cardiomyopathy after 9 years of follow-up. In contrast, none of the 229 athletes with normal ECGs had a cardiac event or received a diagnosis of cardiomyopathy 9±3 years after initial evaluation (P=0.001).
Conclusions Markedly abnormal ECGs in young and apparently healthy athletes may represent the initial expression of underlying cardiomyopathies that may not be evident until many years later and that may ultimately be associated with adverse outcomes. Athletes with such ECG patterns merit continued clinical surveillance.
2 mm in at least three leads) who had no apparent cardiac disease and who had undergone serial clinical, ECG, and echocardiographic studies for a mean (±SD) of 9±7 years (range, 1 to 27). Comparisons were made with 229 matched control athletes with normal ECGs from the same database.
Source Information
From the Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome (A.P., F.M.D.P., F.M.Q., R.D.L., A.S., A.B.); the Institute of Pathology, University of Padua Medical School, Padua (C.B., G.T.); the Department of Experimental Medicine, University La Sapienza, Rome (F.C.); and the Department of Diagnostic and Laboratory Services and Forensic Medicine, University of Modena and Reggio Emilia, Modena (G.P.) — all in Italy; and the Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis (B.J.M.).
Address reprint requests to Dr. Pelliccia at the Institute of Sports Medicine and Science, Via dei Campi Sportivi 46, 00197 Rome, Italy, or at ant.pelliccia{at}libero.it.
Related Letters:
Athletes with Repolarization Abnormalities
Efthimiadis G. K., Meditskou S., Parcharidis G. E., Galvin J. M., Arnold J. R., Karamitsos T. D., Petersen S. E., Pelliccia A., Maron B. J.
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N Engl J Med 2008;
358:2296-2298, May 22, 2008.
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