Athletic status was associated with a higher prevalence of Sokolow-Lyon right ventricular hypertrophy compared to sedentary controls (11.8% vs. 6.2%, P=0.017) without underlying RV pathology.
Observational (n=966)
Does isolated electrocardiographic right ventricular hypertrophy indicate underlying right ventricular pathology in young athletes?
Isolated electrocardiographic voltage criteria for right ventricular hypertrophy are common in healthy athletes and do not indicate underlying pathology, suggesting they should not prompt further investigation when observed in isolation.
Absolute Event Rate: 11.8% vs 6.2%
p-value: p=0.017
AIMS: Pre-participation cardiovascular screening of young athletes may prevent sports-related sudden cardiac deaths. Recognition of physiological electrocardiography (ECG) changes in healthy athletes has improved the specificity of screening while maintaining sensitivity for disease. The study objective was to determine the clinical significance of electrocardiographic right ventricular hypertrophy (RVH) in athletes. METHODS AND RESULTS: Between 2010 and 2012, 868 subjects aged 14-35 years (68.8% male) were assessed using ECG and echocardiography (athletes; n = 627, sedentary controls; n = 241). Results were compared against patients with established right ventricular (RV) pathology (arrhythmogenic right ventricular cardiomyopathy, n = 68; pulmonary hypertension, n = 30). Sokolow-Lyon RVH (RV1+SV5orV6 > 1.05 mV) was more prevalent in athletes than controls (11.8 vs. 6.2%, P = 0.017), although RV wall thickness (RVWT) was similar (4.0 ± 1.0 vs. 3.9 ± 0.9 mm, P = 0.18). Athletes exhibiting electrocardiographic RVH were predominantly male (95.9%), and demonstrated similar RV dimensions and function to athletes with normal electrocardiograms (RVWT; 4.0 ± 1.1 vs. 4.0 ± 0.9 mm, P = 0.95, RV basal dimension; 42.7 ± 5.2 vs. 42.1 ± 5.9 mm, P = 0.43, RV fractional area change; 40.6 ± 7.6 vs. 42.2 ± 8.1%, P = 0.14). Sensitivity and specificity of Sokolow-Lyon RVH for echocardiographic RVH (>5 mm) were 14.3 and 88.2%, respectively. Further evaluation including cardiac magnetic resonance imaging did not diagnose right ventricular pathology in any athlete. None of the cardiomyopathic or pulmonary hypertensive patients exhibited voltage RVH without additional ECG abnormalities. CONCLUSION: Electrocardiographic voltage criteria for RVH are frequently fulfilled in healthy athletes without underlying RV pathology, and should not prompt further evaluation if observed in isolation. Recognition of this phenomenon should reduce the burden of investigations after pre-participation ECG screening without compromising sensitivity for disease.
Zaidi et al. (Tue,) conducted a observational in Electrocardiographic right ventricular hypertrophy (n=966). Athletic status vs. Sedentary controls was evaluated on Prevalence of Sokolow-Lyon RVH (p=0.017). Athletic status was associated with a higher prevalence of Sokolow-Lyon right ventricular hypertrophy compared to sedentary controls (11.8% vs. 6.2%, P=0.017) without underlying RV pathology.