Relationship between echocardiographic right-ventricular dimensions and signal-averaged electrocardiogram abnormalities in endurance athletes

Regular physical exercise results in physiological cardiovascular changes. Athletes may demonstrate electrocardiographic changes that can also be seen in certain cardiomyopathies such as arrhythmogenic right-ventricular cardiomyopathy (ARVC). The aim of this study was to assess the prevalence of one such electrocardiographic characteristic, the abnormal signal-averaged ECG (SAECG), and to assess the correlation between SAECG parameters and echocardiographic parameters in athletes participating in sporting disciplines with combined strength and endurance components. We evaluated 24 elite athletes and 27 amateur athletes participating in combined high dynamic and high static (HDHS) sports, using an ECG, SAECG, and a transthoracic echocardiogram. The SAECG was regarded as positive for late potentials if one out of three parameters was abnormal. Prolongation of the filtered QRS duration (fQRS) was present in all of the elite athletes, compared with 74.1% of the amateur athletes (P = 0.011). There was a low prevalence of abnormalities in the other two SAECG parameters [low-amplitude signal (LAS) duration and root-mean-square (RMS) voltage]. The percentage of elite athletes and amateur athletes with a parts per thousand yen2 abnormal SAECG parameters was 8.3 and 7.4% (P = 0.99), respectively. Most of the echocardiographic dimensions were significantly greater in the elite athlete group compared with the amateur athletes. There was a moderate positive correlation between the fQRS and right-ventricular dimensions. The majority of elite and amateur athletes participating in HDHS sports reveal a prolonged fQRS duration on the SAECG, and according to the 2010 Task Force criteria for the diagnosis of ARVC, these athletes therefore demonstrate late potentials. The extent of fQRS prolongation is positively correlated with RV dimensions. Therefore SAECG findings should be interpreted with caution in endurance athletes.