"Athletes with such ECG patterns merit continued clinical surveillance," Dr. Antonio Pelliccia and colleagues write in the New England Journal of Medicine for January 10.

"Reading ECGs in trained athletes is not as simple as previously believed," Dr. Pelliccia added in an interview with Reuters Health.

Dr. Pelliccia's group conducted a case-control study using the 29-year database maintained at the Institute of Sports Medicine and Science in Rome.

From a total of 12,550 athletes, 1% presented with ECGs exhibiting T waves inverted at least 2 mm in at least three leads. Despite these abnormalities, 81 had no initial signs of structural heart disease. Comparisons were made between these 81 subjects and 229 athletes matched by age (range 15 to 38 years), sex, and duration of follow-up (mean nine years).

"The athletes with such abnormal ECG patterns -- in the absence of symptoms, family history of cardiomyopathies or sudden death, or any evidence of cardiac disease on MRI or echocardiography -- were allowed to continue in their training and competitions, but with the obligation of a close follow-up re-evaluation," Dr. Pelliccia noted. "Athletes with any other clues suggesting cardiac disease/abnormality were stopped from competition."

In the case group, five subjects developed cardiomyopathy: one 24-year-old subject died from arrhythmogenic right ventricular cardiomyopathy; hypertrophic cardiomyopathy was identified in three subjects at ages of 27, 32, and 50 years; and dilated cardiomyopathy was diagnosed in the fifth subject at 47 years of age.

None of the control subjects with normal ECGs developed cardiomyopathy. Other cardiovascular conditions occurred in six case subjects and four control subjects (overall incidence of cardiovascular abnormalities, 14% and 2%, respectively, p = 0.001).

The investigators conclude that abnormal ECG findings in young healthy athletes may represent "the initial expression of underlying cardiomyopathies that may not be evident until many years later."

When athletes present with obvious repolarization abnormalities on ECG during preparticipation screening, "we recommend imaging techniques, such as echocardiography or MRI, as first line testing," Dr. Pelliccia advised. "Other testing may be justified according to clinical suspicion."

"When no abnormality is found at initial cardiac evaluation, we suggest periodic re-assessment, at least annually."

By Karla Gale

Last Updated: 2008-01-10 15:29:38 -0400 (Reuters Health)

N Engl J Med 2008;358:152-161.

Related Reading

Playing their hearts out: Do young athletes need cardiac screening?, August 16, 2005

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