Key result
Adolescent African athletes show over double the rate of ECG left ventricular hypertrophy versus Caucasian peers.
Why the study?
No data existed on electrocardiographic and echocardiographic characteristics of adolescent African athletes despite reports of LV hypertrophy and ECG abnormalities in adult African athletes.
Do adolescent African athletes have different ECG and echocardiographic characteristics compared to Caucasian athletes?
Cross-Sectional (n=216)
Yes
Do adolescent African athletes have different ECG and echocardiographic characteristics compared to Caucasian athletes?
Absolute Event Rate: 89% vs 42%
p-value: p=<0.001
Adolescent African athletes exhibit a high prevalence of ECG abnormalities and disproportionate LV wall thickening compared to Caucasian athletes, which should be recognized as normal physiological adaptation rather than pathology.
OBJECTIVES: The goal of this study was to define electrocardiographic (ECG) and echocardiographic characteristics of adolescent African athletes. BACKGROUND: Recent observations in African athletes reported large prevalence of left ventricular (LV) hypertrophy and ECG abnormalities. No data, so far, exist for adolescent Africans, which comprise a growing proportion of competitive/professional athletes. METHODS: The study included 154 soccer players participating at the 8th African Under-17 Championship of 2009, representing Algeria, Burkina Faso, Cameroon, Gambia, Guinea, Malawi, Nigeria, and Zimbabwe. For comparison, 62 Italian players with similar ages, sport achievements, and training schedules were included. RESULTS: African athletes showed higher R5/S1-wave voltages than Caucasian athletes (48.6 ± 12.1 mm vs. 34.1 ± 8.9 mm; p < 0.01), larger prevalence of ECG LV hypertrophy (89% vs. 42%; p < 0.001), ST-segment elevation (91% vs. 56%; p < 0.001), and deeply inverted, or diffusely flat/biphasic, T waves (14% vs. 3% [p < 0.05] and 25% vs. 8% [p < 0.008], respectively). LV wall thicknesses were increased in Africans by 5% compared with Caucasians, and exceeded normal limits (≥13 mm) in 4 Africans but in no Caucasians. No athlete showed evidence of cardiomyopathies (i.e., hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy). On individual analysis, Algerians showed lower R/S-wave voltages compared with other African athletes. Increased wall thickness (≥13 mm) was observed only in sub-Saharian athletes (from Burkina Faso, Cameroon, and Niger). CONCLUSIONS: African athletes displayed large proportion of ECG abnormalities, including a striking increase in R/S-wave voltage, ST-segment elevation, and deeply inverted or diffusely flat T waves by adolescence. LV remodeling in African athletes was characterized by a disproportionate wall thickening than in Caucasians but similar cavity size. Finally, distinctive peculiarities existed in African athletes according to the country (and ethnic) origin.
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Paolo et al. (2012) conducted a cross-sectional in Athlete's heart (n=216). African origin vs. Caucasian (Italian) origin was evaluated on ECG left ventricular hypertrophy (p=<0.001). Adolescent African athletes exhibited a significantly higher prevalence of ECG left ventricular hypertrophy compared to Caucasian athletes (89% vs. 42%; p<0.001).
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