Low QRS voltage was present in 11.4% of Paralympic athletes (27.6% in those with spinal cord injury) and was associated with reduced VO2 max (23.1 vs 37 ml/min/kg; p<0.0001) but no cardiomyopathies.
Cross-Sectional (n=193)
Low QRS voltage is unexpectedly common in Paralympic athletes, particularly those with spinal cord injury, and appears to reflect a benign physiological cardiac phenotype rather than underlying cardiomyopathy.
Absolute Event Rate: 23.1% vs 37%
p-value: p=<0.0001
Abstract Background Low QRS voltage (LQRSV) is considered an uncommon electrocardiographic finding in able-bodied athletes and is investigated to exclude underlying cardiomyopathy. Its prevalence and clinical meaning in Paralympic athletes, particularly those with spinal cord injury (SCI), remain unknown. Purpose The aim of the present study was to characterize the prevalence of LQRSV in a contemporary cohort of elite Paralympic athletes undergoing comprehensive pre-participation cardiovascular evaluation and to assess whether LQRSV is associated with structural cardiac abnormalities or cardiomyopathy, and to determine whether its expression differs between Paralympic athletes with and without SCI. Methods We evaluated 193 elite Italian Paralympic athletes (PA) preparing for the Paris 2024 and Milano-Cortina 2026 Olympic Games. All athletes underwent anthropometric assessment, standard 12-lead ECG, comprehensive echocardiography, and cardiopulmonary exercise testing (CPET). Athletes were classified according to disability (SCI vs. non-SCI). LQRSV was defined according to international criteria. Clinical, functional, and echocardiographic characteristics were compared between athletes with and without LQRSV. Results The 193 Paralympic athletes had mean age 32.7±9.7 years, and 44% were females. LQRSV was identified in 22 athletes (11.4%), with a markedly higher prevalence among those with SCI (27.6%). Athletes with LQRSV were older (p=0.01), more frequently involved in skill-based sports (p0.0001), and predominantly SCI (p0.0001). Compared with athletes with normal ECG voltages, those with LQRSV exhibited significantly reduced exercise performance (VO2 max 23.1±10.5 vs. 37±14.5 ml/min/kg; p 0.0001), lower O2 pulse (p 0.0001) and peak heart rate (p=0.024). Echocardiography revealed smaller left ventricular (LV) volumes and LV mass, while systolic function was preserved (p=0.488). Among SCI athletes, those with LQRSV demonstrated higher fat mass (p=0.035). No major structural cardiac abnormalities or cardiomyopathies were identified in athletes with LQRSV, and none developed patent cardiovascular disease on medium-term (8.3 ± 4.2 years) follow-up. Conclusions LQRSV shows an unexpectedly high prevalence in Paralympic athletes, particularly those with SCI, and may reflects the cardiac phenotype characterized by smaller cardiac chambers and reduced metabolic drive. These findings support the need for disability-specific ECG interpretation criteria in Paralympic sport.
Ferrera et al. (Mon,) conducted a cross-sectional in Elite Paralympic athletes (n=193). Low QRS voltage (LQRSV) vs. Normal ECG voltages was evaluated on VO2 max (ml/min/kg) (p=<0.0001). Low QRS voltage was present in 11.4% of Paralympic athletes (27.6% in those with spinal cord injury) and was associated with reduced VO2 max (23.1 vs 37 ml/min/kg; p<0.0001) but no cardiomyopathies.
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