You've got to be in it to win it: the importance of including female athletes in screening ECG cohorts

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Janssens ◽  
E Paratz ◽  
M Brosnan ◽  
A Lindqvist ◽  
A Mitchell ◽  
...  
Keyword(s):  
Athletic Training ◽  
Female Athletes ◽  
Left Ventricular ◽  
Endurance Athletes ◽  
Qtc Interval ◽  
Male Athletes ◽  
Wave Inversion ◽  
Training Response ◽  
Healthy Female ◽  
Qrs Duration

Abstract Background ECG screening is widely employed in athletic populations with the aim of identifying cardiac conditions associated with sudden death. Recommendations for athlete ECG interpretation are disproportionately reliant on data from male athletes and sex-specific differences have not been adequately elucidated. Purpose The aim of this study is to identify any different patterns in female athletic training response on ECG screening. Methods 444 elite athletes (156 male rowers, 135 female rowers, 117 male cricketers, 36 female cricketers) underwent electrocardiogram (ECG) screening. Standard definitions were used to characterize abnormalities identified on ECG. Comparisons were made according to sex and endurance (rowing) vs skill-based (cricket) athletes (EA and SBA respectively). Results “Potentially pathological” T-wave inversion extending to V3 was more prevalent in female athletes (9.9% vs. 2.9%, P=0.002), especially amongst endurance athletes (11.9% female EA vs. 2.8% female SBA, P=0.004) (Figure 1). As compared with males, the QTc interval was longer in female athletes (418 vs. 402ms), the QRS duration was shorter (90 vs. 100 ms) and left ventricular hypertrophy on voltage criteria were less prevalent (9.9% vs. 33.3%, P<0.001 for all). First-degree heart block and incomplete right bundle branch block were more prevalent amongst male athletes. Conclusion Female athletes exhibit different training-related cardiac remodelling responses to exercise compared to males. A greater proportion of ostensibly healthy female athletes, especially female endurance athletes, have ECG changes that would be deemed “potentially pathological” according to current sex-agnostic guidelines. Figure 1 Funding Acknowledgement Type of funding source: None

Hinge point fibrosis in athletes is not associated with structural, functional or electrical consequences: a comparison between young and middle-aged elite endurance athletes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R De Bosscher ◽  
M Claeys ◽  
C Dausin ◽  
K Goetschalckx ◽  
J Bogaert ◽  
...  
Keyword(s):  
Female Athletes ◽  
Maximal Oxygen Consumption ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Endurance Athletes ◽  
Funding Source ◽  
Middle Aged ◽  
National Budget ◽  
Hinge Point ◽  
Wave Inversion

Abstract Background The health benefits of extensive endurance training have been debated due to the report of myocardial fibrosis (MF), arrhythmias and temporary post-race cardiac impairment in middle-aged and veteran athletes. The extent of these changes is unknown in elite young athletes. Purpose To assess the prevalence of MF and its structural, functional and electrical impact in highly trained young endurance athletes (YA, 15–23 years) as compared to middle-aged athletes (MA, 30–50 years). We hypothesised that MF would be more frequent in MA and associated with more structural, functional and electrical abnormalities. Methods We prospectively assessed 197 YA and 34 MA. All had ECG, maximal oxygen consumption (VO2max) testing, cardiac magnetic resonance imaging (CMR), echocardiography and 24h-holter. Indexed left ventricular and right ventricular end diastolic volume (LVEDVi, RVEDVi), ejection fraction (LVEF, RVEF), left ventricular mass (LVMi), and MF defined as delayed gadolinium enhancement were assessed by CMR. LV and RV free wall strain (LVSL, RVfwSL) were assessed by 2D speckle tracking echocardiography. Ventricular premature beats (VPB) and non-sustained ventricular tachycardia (nsVT) were assessed by 24h-holter. Results YA and MA (18±2 vs 38±5 years [p<0.01]; 78% vs 80% male [p=0.99]) with an elite level of fitness (VO2max 61±8 vs 54±10 mL/min/kg [p<0.01]; % predicted VO2max 150±20 vs 158±30 [p=0.02]) had a large variance in LV and RV remodelling (Figure 1). MF was seen in 28 athletes (12.5%) and more prevalent in MA than in YA (23.5 vs 10.5%, p=0.048). MF was limited to the hinge points in all 8 MA with MF and 17 YA. 3 YA had LV lateral wall subepicardial MF. 27 of 187 (14.4%) male athletes had MF compared to 1 of 50 (2%) female athletes (p=0.01). MF+ MA(A) and YA(B) as well as MF− MA(C) and YA(D) had similar structural remodelling (LVEDVi 110±14 vs 118±14 vs 113±19 vs 110±16 mL/m2; RVEDVi 120±14 vs 128±17 vs 117±19 vs 125±23mL/m2; LVMi 77±11 vs 83±14 vs 81±14 vs 77±15g/m2, p>0.05). LVEF, LVSL and RVSL were similar (59±3 vs 58±5 vs 61±6 vs 58±6%; −18.8±2 vs −18.8±2 vs −19.8±2 vs −19.3±2%; −26.3±2.4 vs −24.4±2.4; −26.3±3 vs −25.8±3.5% respectively, p>0.05). LVEF <50% was seen in 19 (8.2%) athletes (0 [0%] vs [5%] 1 vs 1 [3.8%] vs 17 [9.6%]; p=0.51). RVEF was higher in D compared to C without further differences between groups (54±4 vs 54±6 vs 53±6 vs 57±5, p=0.005). RVEF<45% was seen 21 (9.1%) athletes (0 [0%] vs 1 [5%] vs 0 [0%] vs 20 [11.3%]; p=0.14). Abnormal T-wave inversion was similar (12.5 vs 5 vs 7.4 vs 6.2%, p=0.93) as was the prevalence of >100VPB/24h (12.5 vs 5 vs 11.1 vs 5.1%, p=0.42). 2 athletes had nsVT, both in D. All had similar exercise capacity (% predicted VO2max 157±26 vs 152±15 vs 147±24 vs 158±32%; p=0.11). Conclusion Hinge-point fibrosis was more prevalent in MA, possibly due to repeated hemodynamic stress during exercise, but is not associated with structural, functional or electrical consequences. Figure 1. Cardiac remodelling in elite athletes Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fonds voor Wetenschappelijk Onderzoek (FWO)

Cardiovascular adaptation to exercise and sport: (according to type of sport, gender, and ethnicity)

ESC CardioMed ◽  
2018 ◽  
pp. 2913-2916
Author(s):  
Michael Papadakis ◽  
Sanjay Sharma
Keyword(s):  
Female Athletes ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Endurance Athletes ◽  
Physiological Adaptation ◽  
Imaging Studies ◽  
Eccentric Hypertrophy ◽  
Athlete's Heart ◽  
Adaptation To Exercise

‘Athlete’s heart’ is associated with several structural and electrophysiological adaptations, which are reflected on the 12-lead electrocardiogram (ECG) and imaging studies. Most studies investigating cardiac remodelling in athletes are based on cohorts of white, adult, male athletes competing in the most popular sports. Evidence suggests, however, that sporting discipline and the athlete’s gender and ethnicity are important determinants of cardiovascular adaptation to exercise. Athletes competing in endurance sports demonstrate more pronounced adaptations in comparison to athletes performing static or resistance training. The ECG of endurance athletes is more likely to demonstrate repolarization anomalies in the anterior leads and ventricular dilatation on imaging studies, causing considerable overlap with arrhythmogenic right ventricular cardiomyopathy and dilated cardiomyopathy. Female athletes exhibit less pronounced adaptations compared to males, in terms of the prevalence of ECG changes and absolute cardiac dimensions. Importantly, female endurance athletes are more likely to demonstrate eccentric hypertrophy compared to males, suggesting that concentric remodelling or hypertrophy in female endurance athletes is unlikely to be the consequence of physiological adaptation to training. The most pronounced paradigm of ethnically distinct cardiovascular adaptation to exercise stems from black athletes, who exhibit a significantly higher prevalence of repolarization anomalies and left ventricular hypertrophy compared to white athletes, making the differentiation between athlete’s heart and hypertrophic cardiomyopathy challenging in this ethnic group.

scholarly journals Antiarrhythmic Effect of Sacubitril-Valsartan: Cause or Consequence of Clinical Improvement?

2019 ◽  
Vol 8 (6) ◽  
pp. 869 ◽  
Author(s):  
António Valentim Gonçalves ◽  
Tiago Pereira-da-Silva ◽  
Ana Galrinho ◽  
Pedro Rio ◽  
Luísa Moura Branco ◽  
...  
Keyword(s):  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Antiarrhythmic Effect ◽  
Qtc Interval ◽  
Dispersion Index ◽  
Time Intervals ◽  
Mechanical Dispersion ◽  
Before And After ◽  
Qrs Duration

Sacubitril/Valsartan (LCZ696) reduced sudden cardiac death in the PARADIGM-HF trial. However, the mechanism by which LCZ696 reduces ventricular arrhythmias remains unclear. The aim of this study was to compare electrocardiographic (ECG) parameters and mechanical dispersion index, assessed by left ventricular (LV) global longitudinal strain (GLS), before and after LCZ696 therapy. We prospectively evaluated chronic Heart Failure (HF) patients with LV ejection fraction ≤40%, despite optimal medical and device therapy, in which LCZ696 therapy was started, while no additional HF treatment was expected to change. ECG and transthoracic echocardiographic data were gathered in the week before starting LCZ696 and at six months of therapy. A semiautomated analysis of LV GLS was performed and mechanical dispersion index was defined as the standard deviation from 16 time intervals corresponding to each LV segment. Of the 42 patients, 35 completed the six month follow-up, since two patients died and five discontinued treatment for adverse events. QTc interval (451.9 vs. 426.0 ms, p < 0.001), QRS duration (125.1 vs. 120.8 ms, p = 0.033) and mechanical dispersion index (88.4 vs. 78.1 ms, p = 0.036) were significantly reduced at six months. LCZ696 therapy is associated with a reduction in QTc interval, QRS duration and mechanical dispersion index as assessed by LV GLS.

Cardiac remodeling in middle-aged endurance athletes: relation between signal-averaged electrocardiogram and LV mass

2020 ◽  
Author(s):  
Laura Banks ◽  
Saif Al-Mousawy ◽  
Mustafa A Altaha ◽  
Kaja Koneiczny ◽  
Wesseem Osman ◽  
...  
Keyword(s):  
Cardiac Remodeling ◽  
Left Ventricular ◽  
Endurance Athletes ◽  
Electrical Remodeling ◽  
Middle Aged ◽  
Structural Remodeling ◽  
Endurance Sport ◽  
End Diastolic Volume ◽  
Lv Mass ◽  
Qrs Duration

Background: The relationship between structural and electrical remodeling in the heart, particularly after long-standing endurance training, remains unclear. Signal-averaged electrocardiogram (SAECG) may provide a more sensitive method to evaluate cardiac remodeling than a 12-lead electrocardiogram (ECG). Accurate measures of electrical function (SAECG filtered QRS duration (fQRSd) and late potentials (LP) and left-ventricular mass (cardiac magnetic resonance, CMR) can allow an assessment of structural and electrical remodeling. Methods: Endurance athletes (45-65 years old, >10 years of endurance sport), screened to exclude cardiac disease, had standardized 12-lead ECG, SAECG, resting echocardiogram (ECHO), and CMR performed. SAECG fQRSd was correlated with QRS duration on the 12-lead ECG, and ECHO and CMR-derived left ventricular (LV) mass. Results: Participants (n=82, 67% male, mean age: 54±6 years, mean VO2max: 50±7 ml/kg/min) had a CMR-derived LV mass of 118±28 g/m2 and a fQRSd of 112±8 ms (46% had abnormal fQRSd (>114 msec), and 51% met clinical threshold for abnormal SAECG). fQRSd was positively correlated with the 12-lead ECG QRS duration (r=0.83), ECHO-derived LV mass (r=0.60), CMR-derived LV mass (r=0.58) and LV end-diastolic volume (r=0.63, p<0.001 for all). fQRSd had higher correlations with ECHO and CMR-derived LV mass than 12-lead ECG (p<0.0008 and p<0.0005, respectively). Conclusion: In a healthy cohort of middle-aged endurance athletes, the SAECG is often abnormal by conventional criteria, and is correlated with structural remodeling, but CMR evaluation does not indicate pathologic structural remodeling. SAECG fQRSd is superior to the 12-lead ECG for the electrocardiographic evaluation of LV mass.

The Motivational Climate and Intrinsic Motivation in the Rehabilitation Setting

2018 ◽  
Vol 27 (5) ◽  
pp. 460-468 ◽  
Author(s):  
Rachel E. Brinkman-Majewski ◽  
Windee M. Weiss
Keyword(s):  
Intrinsic Motivation ◽  
Goal Orientation ◽  
Athletic Training ◽  
Effect Size ◽  
Female Athletes ◽  
Athletic Trainers ◽  
Motivational Climate ◽  
Therapeutic Interventions ◽  
Athletic Trainer ◽  
Male Athletes

Context: The motivational climate created by the athletic trainer in rehabilitation may be critical in influencing athletes’ intrinsic motivation and other psychosocial outcomes in the rehabilitation and the recovery processes. Objective: To examine intercollege athletes’ perceptions of the motivational climate in the rehabilitation setting. Specifically, examining if perceptions of the motivational climate can predict athletes’ levels of intrinsic motivation with rehabilitation as well as the relationship between perceptions of the motivational climate and athlete demographics (gender, starter status, athletic trainer gender, etc). Design: Cross-sectional, descriptive research. Setting: College sport team and athletic training center. Participants: National Collegiate Athletic Association Division II intercollege athletes from one institution (n = 187; 125 males and 62 females). Main Outcome Measures: Paper-based survey measuring mastery and performance perceptions of the motivational climate in rehabilitation, athletes’ goal orientation in sport, and athletes’ levels of motivation in rehabilitation. Results: Perceptions of a performance climate were positively related to intrinsic motivation effort–improvement (effect size = 25.34%). Perceptions of a mastery climate were positively related to interest–enjoyment and perceived competence and negatively related to tension–pressure (effect size = 39.03%). In general, female athletes, as well as athletes with a female athletic trainer, had significantly higher perceptions of mastery motivational climate effort–improvement than male athletes and athletes with male athletic trainers. While male athletes and athletes with male athletic trainers had higher perceptions of intrateam member rivalry in rehabilitation. Conclusions: The athlete’s gender and goal orientation, as well as the gender of the athletic trainer creating the motivational climate, can influence whether the environment is perceived as more mastery or performance. The recovering athletes’ perceptions of the climate in rehabilitation can, in turn, affect their intrinsic motivation toward the therapeutic interventions.

College Athletes’ Expectations About Injury Rehabilitation With an Athletic Trainer

2012 ◽  
Vol 17 (4) ◽  
pp. 18-25 ◽  
Author(s):  
Joe Hart ◽  
Damien Clement ◽  
Jordan Hamson-Utley ◽  
Monna Arvinen-Barrow ◽  
Cindra Kamphoff ◽  
...  
Keyword(s):  
Athletic Training ◽  
Student Athletes ◽  
Female Athletes ◽  
Outcome Measure ◽  
Prior Experience ◽  
Athletic Trainer ◽  
Male Athletes ◽  
Injury Rehabilitation ◽  
Rehabilitation Process ◽  
Main Outcome Measure

Context:Injured athletes begin the rehabilitation process with expectations about the nature of the working relationship with an athletic trainer. These expectations can infuence the effectiveness of the assistance provided.Objective:To determine whether male and female athletes differed in terms of expectations about injury rehabilitation services with an athletic trainer.Design:A questionnaire was administered to student athletes that assessed expectations about injury rehabilitation. Setting: Five colleges and universities.Patients or Other Participants:Questionnaire responses were provided by 679 student athletes (443 males and 236 females).Main Outcome Measure:Responses to the Expectations about Athletic Training questionnaire were used to assess factors identifed as Personal Commitment, Facilitative Conditions, Athletic Trainer Expertise, and Realism.Results:A statistically signifcant interaction between gender and prior experience was identifed. Male athletes with no prior experience had lower expectations for a facilitative environment. Female athletes with prior experience were less likely to have realistic expectations.Conclusions:Gender and prior experience infuence athletes’ expectations of injury rehabilitation with an athletic trainer.

scholarly journals Eating Disorder Symptoms in Elite Spanish Athletes: Prevalence and Sport-Specific Weight Pressures

2021 ◽  
Vol 11 ◽  
Author(s):  
Clara Teixidor-Batlle ◽  
Carles Ventura ◽  
Ana Andrés
Keyword(s):  
Eating Disorder ◽  
Elite Athlete ◽  
Female Athletes ◽  
National Level ◽  
Specific Weight ◽  
Eating Attitudes ◽  
Endurance Athletes ◽  
Male Athletes ◽  
Eating Disorder Symptoms ◽  
Competition Level

We determined the prevalence of eating disorder (ED) symptoms among elite Spanish athletes from a broad range of sports and levels of competition and examined the associations between the presence of symptoms and perceived sport-specific weight pressures. We surveyed 646 elite athletes (16.7 ± 4.4 years; 51.08% females) representing 33 sports from top-division teams and two elite athlete training centers in Catalonia. Based on the results of the Eating Attitudes Test-26 responses, 5.1% of athletes (7.6% of females and 2.5% of males) were at risk of EDs. The highest rates of ED symptoms were observed in male endurance athletes and female esthetic athletes. Competition level was not a risk factor. The only gender differences in the presence of ED symptoms by competing level were observed in athletes competing at the national level. Female athletes with ED symptoms scored higher on the two subscales of the Spanish version of the Weight Pressures in Sport (WPS) tool: coach and sport-specific pressures and pressures from teammates and due to uniform. Male athletes with ED symptoms scored higher on the pressures due to uniform subscale. Finally, symptomatic female but not male athletes competing at international and national levels also perceived greater sport-specific weight pressures.

scholarly journals The Female Athlete’s Heart: Overview and Management of Cardiovascular Diseases

2021 ◽  
Vol 16 ◽  
Author(s):  
Silvia Castelletti ◽  
Sabiha Gati
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Female Athletes ◽  
Cardiovascular Disorders ◽  
Lower Prevalence ◽  
Male Athletes ◽  
T Wave ◽  
Wave Inversion ◽  
Amateur Sport ◽  
Lifelong Exercise

The number of female athletes taking part in elite and amateur sport is ever increasing. In contrast with male athletes, few studies have focused on cardiovascular adaptations to exercise in women, the effects of lifelong exercise on heart muscle and electrical tissue, the risk of exercise-related sudden cardiac death and the management of cardiovascular disease. Women have a lower prevalence of large QRS complexes, repolarisation changes including inferior and lateral T-wave inversion, and cardiac dimensions exceeding predicted limits compared with men. The risk of exercise-related sudden cardiac death is significantly lower in women than men. Also, women who have engaged in lifelong exercise do not have a higher prevalence of AF, coronary artery calcification or myocardial fibrosis than their sedentary counterparts. Apart from providing an overview of the existing literature relating to cardiac adaptations, this review explores possible reasons for the sex differences and focuses on the management of cardiovascular disorders that affect female athletes.

scholarly journals Electrocardiographic and Echocardiographic Insights From a Prospective Registry of Asian Elite Athletes

2022 ◽  
Vol 8 ◽  
Author(s):  
Tee Joo Yeo ◽  
Mingchang Wang ◽  
Robert Grignani ◽  
James McKinney ◽  
Lay Pheng Koh ◽  
...  
Keyword(s):  
Female Athletes ◽  
Elite Athletes ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Left Ventricular Cavity ◽  
Male Athletes ◽  
Endurance Sport ◽  
Electrocardiogram Ecg ◽  
Athlete's Heart

Background: Asian representation in sport is increasing, yet there remains a lack of reference values for the Asian athlete's heart. Consequently, current guidelines for cardiovascular screening recommend using Caucasian athletes' norms to evaluate Asian athletes. This study aims to outline electrocardiographic and echocardiographic characteristics of the Asian athlete's heart using a Singaporean prospective registry of Southeast (SE) Asian athletes.Methods and Results: One hundred and fifty elite athletes, mean age of 26.1 ± 5.7 years (50% males, 88% Chinese), were evaluated using a questionnaire, 12-lead electrocardiogram (ECG) and transthoracic echocardiogram. All ECGs were analyzed using the 2017 International Recommendations. Echocardiographic data were presented by gender and sporting discipline. The prevalence of abnormal ECGs among SE Asian athletes was 6.7%—higher than reported figures for Caucasian athletes. The abnormal ECGs comprised mainly anterior T wave inversions (ATWI) beyond lead V2, predominantly in female athletes from mixed/endurance sport (9.3% prevalence amongst females). None had echocardiographic structural abnormalities. Male athletes had reduced global longitudinal strain compared to females (−18.7 ± 1.6 vs. −20.7 ± 2.1%, p &lt; 0.001). Overall, SE Asian athletes had smaller left ventricular cavity sizes and wall thickness compared to non-Asian athletes.Conclusion: SE Asian athletes have higher abnormal ECG rates compared to Caucasian athletes, and also demonstrate structural differences that should be accounted for when interpreting their echocardiograms compared to athletes of other ethnicities.

Abstract 3391: Prevalence Of Hypertrophic Cardiomyopathy In Elite Athletes

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Sandeep Basavarajaiah ◽  
Mathew Wilson ◽  
Agnes Chlebinska ◽  
Arash Yavari ◽  
Gordon Jackson ◽  
...  
Keyword(s):  
Elite Athletes ◽  
Cardiopulmonary Exercise Testing ◽  
Left Ventricular ◽  
Male Athletes ◽  
Functional Changes ◽  
Wave Inversion ◽  
2D Echocardiography ◽  
History Of ◽  
Ventricular Wall Thickness ◽  
And Function

Objectives: The prevalence of HCM in the general population is estimated to be around 1 in 500. The exact prevalence of HCM in athletes has never been reported and has important implications with regards to potential future national pre-participation screening programme in countries such as United Kingdom, where currently there is no such programme for junior athletes. Methods: Between 1996 and 2006, 3500 asymptomatic and normotensive elite athletes (70% males) aged between 14–35 years (mean: 20.5±5.80) and a mean body surface area of 1.86±0.16 m 2 (range1.36–2.29) underwent 12-lead EKG and 2D-echocardiography. Cardiac dimensions and function were measured using conventional methods. Results: Of the 3500 athletes, 53 (2%) had maximal left ventricular wall thickness (LVWTd) > 12 mm (mean: 13.6 ± 0.9, range: 13–16). All 53 were male athletes and all except 3 of them had associated dilated LV cavity (58.5 ± 5.14 mm, range 52– 65) implying physiological left ventricular hypertrophy (LVH). This was also supported by normal indices of diastolic function and absence of family history of HCM or sudden cardiac death (SCD). However, there were 3 athletes with LVWT > 12mm who had a relatively non-dilated LV cavity (range:45– 46) and bizarre EKG changes (deep T-wave inversion) that that raised the suspicion of HCM. But none of them exhibited any other phenotypic feature of HCM on further testing with 48-hour EKG recording, cardiopulmonary exercise testing and assessment of their first-degree family members. Only one of the 3 athletes agreed to detrain for 12-weeks, which resulted in regression of LVH and complete resolution of EKG changes. Conclusion: In our study, only 3 athletes had echocardiographic findings that could have been consisted with the diagnosis of HCM but further investigations failed to support the diagnosis. These results indicate that the prevalence of HCM in highly trained athletes is extremely rare. The structural and functional changes associated with HCM precludes generation of large amounts of cardiac output that are required during exercise selecting out most of these individuals from competitive sports. Our findings also questions the validity of previous data which proposes that HCM is the commonest cause of exercise related SCD in young athletes.

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