Alterations in echocardiographic and electrocardiographic features in Japanese professional soccer players: comparison to African-Caucasian ethnicities

Abstract

Background:

Scarce data are available regarding the electrocardiographic (ECG) and echocardiographic changes in athletes of Asian origin.

Design:

We investigate the ECG and echocardiographic patterns in Japanese (J) compared with African-Caribbean (AC) and Caucasian (C) athletes.

Methods:

A total of 282 professional soccer players (68 J, 96 AC and 118 C) matched for age, gender, sport and level of achievement was examined.

Results:

ECGs were without alterations in 62% of J (versus 69% of C, p = non significant and 44% of AC, p < 0.001). The most common alterations in J were sinus bradycardia (69%), incomplete right bundle branch block (RBBB; 43%), early repolarization (18%), isolated increase in R/S-wave (10%), Q-waves (9%). Remarkably, no J athlete showed deeply T-wave inversion, in contrast to 6% of AC (p < 0.05). Occasionally, J showed J-point upward/domed ST-elevation with inverted/biphasic T-wave (6% versus 16.5% in AC, p < 0.01). J demonstrated larger left ventricular (LV) cavity compared with AC and C players (55.2 ± 3.3 versus 52.2 ± 3.8 and 53.9 ± 3.7 mm, respectively, p < 0.01), with an important subset ( > 4%) presenting a markedly enlarged cavity (>60 mm), in the presence of normal systolic/diastolic function and no segmental abnormalities. Therefore, J showed a more eccentric remodelling compared with AC and C (relative wall thickness: 0.31 ± 0.05, 0.38 ± 0.06 and 0.36 ± 0.06, respectively, p < 0.01).

Conclusion:

J players show the most eccentric LV remodelling compared with C and AC players. In association, certain training-related ECG patterns, i.e. sinus bradycardia and isolated increase in R/S-wave voltage, are present in a larger proportion of J players than previously described in C players. Conversely, no J athlete showed deeply T-wave inversion, as commonly found in AC and occasionally in C.

Keywords

Athlete’s heart soccer ethnicity echocardiography electrocardiography

Get full access to this article

View all access options for this article.

References

Pluim

Zwinderman

Van Der Laarse

. The athlete’s heart: a meta-analysis of cardiac structure and function. Circulation 2000; 101: 336–344.

Pelliccia

Maron

Culasso

. Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation 2000; 102: 278–284.

Maron

Pelliccia

. The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation 2006; 114: 1633–1644.

Corrado

Pelliccia

Heidbuchel

. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J 2010; 31: 243–259.

Maron

Zipes

. 36th Bethesda Conference. Eligibility recommendations for competitive athletes with cardiovascular abnormalities. J Am Coll Cardiol 2005; 45: 1321–1375.

Barbier

Ville

Kervio

. Sports-specific features of athlete’s heart and their relation to echocardiographic parameters. Herz 2006; 31: 531–543.

Petersen

Hudsmith

Robson

. Sex-specific characteristics of cardiac function, geometry and mass in young adult elite athletes. J Magn Reson Imaging 2006; 24: 297–303.

Basavarajaiah

Boraita

Whyte

. Ethnic differences in left ventricular remodelling in highly-trained athletes relevance to differentiating physiologic left ventricular hypertrophy from hypertrophic cardiomyopathy. J Am Coll Cardiol 2008; 51: 2256–2262.

Magalski

Maron

Main

. Relation of race to electrocardiographic patterns in elite American football players. J Am Coll Cardiol 2008; 51: 2250–2255.

10.

Rawlins

Carre

Kervio

. Ethnic differences in physiological cardiac adaptation to intense physical exercise in highly trained female athletes. Circulation 2010; 121: 1078–1085.

11.

Maron

Carney

Lever

. Relationship of race to sudden cardiac death in competitive athletes with hypertrophic cardiomyopathy. J Am Coll Cardiol 2003; 41: 974–980.

12.

Papadakis

Carre

Kervio

. The prevalence, distribution, and clinical outcomes of electrocardiographic repolarization patterns in male athletes of African/Afro-Caribbean origin. Eur Heart J 2011; 32: 2304–2313.

13.

Wilson MG, Chatard JC, Carre F, et al. Prevalence of electrocardiographic abnormalities in West-Asian and African male athletes. Br J Sports Med 2012; 46: 341–347.

14.

Nagashima

Musha

Takada

. New upper limit of physiologic cardiac hypertrophy in Japanese participants in the 100-km ultramarathon. J Am Coll Cardiol 2003; 42: 1617–1623.

15.

Dai

Sun

. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death in China. J Sci Med Sport 2007; 10: 227–233.

16.

Sun

Yong

. The upper limit of physiological cardiac hypertrophy in elite male and female athletes in China. Eur J Appl Physiol 2007; 101: 457–463.

17.

Laskowski

Wysocki

Multan

. Changes in cardiac structure and function among elite judoist resulting from long-term judo practice. J Sports Med Phys Fitness 2008; 48: 366–370.

18.

Scharhag

Urhausen

Kindermann

. Suggested new upper limit of physiologic cardiac hypertrophy determined in Japanese ultra-marathon runners must be interpreted cautiously. J Am Coll Cardiol 2004; 44: 469–474.

19.

Bazett

. An analysis of the time relations of electrocardiograms. Heart 1920; 7: 353–367.

20.

Sokolow

Lyon

. The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and lim leads. Am Heart J 1949; 37: 161–186.

21.

Lang

Bierig

Devereux

. Recommendations for chamber quantification. Eur J Echocardiogr 2006; 7: 79–108.

22.

Devereux

. Detection of left ventricular hypertrophy by M-mode echocardiography: anatomic validation, standardization and comparison to other methods. Hypertension 1987; 9: 19–26.

23.

Pressler A, Haller B Scherr J, et al. Association of body composition and left ventricular dimensions in elite athletes. Eur J Cardiovasc Prev Rehabil 2011 (in press).

24.

Otterstad

Froeland

St. John Sutton

. Accuracy and reproducibility of biplane two-dimensional echocardiographic measurements of left ventricular dimensions and function. Eur Heart J 1997; 18: 507–513.

25.

Lewis

Spirito

Pellicia

. Usefulness of Doppler echocardiographic assessment of diastolic filling in distinguishing “athlete’s heart” from hypertrophic cardiomyopathy. Br Heart J 1992; 68: 296–300.

26.

Maron

Mc Kenna

Danielson

. A report of the ACC Foundation Task Force on Clinical Expert Consensus Documents and the ESC Committee for Practice Guidelines Committee to Develop an Expert Consensus Document on Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2003; 42: 1687–1713.

27.

Marcus

Mc Kenna

Sherrill

. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the Task Force Criteria. Eur Heart J 2010; 31: 806–814.

28.

Pelliccia

Di Paolo

Quattrini

. Outcomes in athletes with marked ECG repolarization abnormalities. N Engl J Med 2008; 358: 152–161.

29.

Pelliccia

Culasso

Di Paolo

. Physiologic left ventricular cavity dilatation in elite athletes. Ann Intern Med 1999; 130: 23–31.

30.

Pelliccia

. Differences in cardiac remodeling associated with race implications for pre-participation screening and the unfavorable situation of black athletes. J Am Coll Cardiol 2008; 51: 2263–2265.

31.

Maron

. Sudden death in hypertrophic cardiomyopathy. J Cardiovasc Transl Res 2009; 2: 368–380.