Electrocardiographic and Echocardiographic Insights From a Prospective Registry of Asian Elite Athletes.

Tee Joo Yeo,Gregory Chung Tsing Chan,Mingchang Wang,Nigel Tay,Robert Grignani,Chi-Hang Lee,James Mckinney,Siew-Pang Chan,Aneil Malhotra,Frankie Hun Yau Tan,Sanjay Sharma,David Oxborough,Arthur Mark Richards,Lay Pheng Koh

doi:10.3389/fcvm.2021.799129

Abstract

Background: Asian representation in sport is increasing, yet there remains a lack of reference values for the Asian athlete's heart. Consequently, current guidelines for cardiovascular screening recommend using Caucasian athletes' norms to evaluate Asian athletes. This study aims to outline electrocardiographic and echocardiographic characteristics of the Asian athlete's heart using a Singaporean prospective registry of Southeast (SE) Asian athletes.Methods and Results: One hundred and fifty elite athletes, mean age of 26.1 ± 5.7 years (50% males, 88% Chinese), were evaluated using a questionnaire, 12-lead electrocardiogram (ECG) and transthoracic echocardiogram. All ECGs were analyzed using the 2017 International Recommendations. Echocardiographic data were presented by gender and sporting discipline. The prevalence of abnormal ECGs among SE Asian athletes was 6.7%—higher than reported figures for Caucasian athletes. The abnormal ECGs comprised mainly anterior T wave inversions (ATWI) beyond lead V2, predominantly in female athletes from mixed/endurance sport (9.3% prevalence amongst females). None had echocardiographic structural abnormalities. Male athletes had reduced global longitudinal strain compared to females (−18.7 ± 1.6 vs. −20.7 ± 2.1%, p < 0.001). Overall, SE Asian athletes had smaller left ventricular cavity sizes and wall thickness compared to non-Asian athletes.Conclusion: SE Asian athletes have higher abnormal ECG rates compared to Caucasian athletes, and also demonstrate structural differences that should be accounted for when interpreting their echocardiograms compared to athletes of other ethnicities.

Highlights

Asian athletes feature prominently in international competitive sport and continue to show improvement at the pinnacle of physical ability—the Olympic Games [1]
Anterior T wave inversions (ATWI) up to lead V2 are deemed physiological in Caucasian athletes, whereas in Black athletes, anterior T wave inversions (ATWI) up to lead V4 are considered within normal limits when preceded by J-point elevation and convex ST segment elevation
This study aims to highlight ECG and echocardiographic characteristics for Asian athletes via a prospective registry of athletes from Southeast (SE) Asia

Summary

Introduction

Asian athletes feature prominently in international competitive sport and continue to show improvement at the pinnacle of physical ability—the Olympic Games [1]. 48 countries combine to form Asia, the largest and most populous continent in the world with a total population exceeding 4.4 billion [2] Despite this enormous population base, there remains a dearth of data for the Asian athlete’s ECG and echocardiogram. Anterior T wave inversions (ATWI) up to lead V2 are deemed physiological in Caucasian athletes, whereas in Black athletes, ATWI up to lead V4 are considered within normal limits when preceded by J-point elevation and convex ST segment elevation. These ECG recommendations have reduced false positive rates substantially while preserving sensitivity in identifying pathology in athletes [4]. This study aims to outline electrocardiographic and echocardiographic characteristics of the Asian athlete’s heart using a Singaporean prospective registry of Southeast (SE) Asian athletes

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Methods

Results

Discussion

Conclusion