Right ventricular assessment of the adolescent footballer’s heart

D. X. Augustine, J. Willis, S. Sivalokanathan, C. Wild, A Sharma, A. Zaidi, K. Pearce, G. Stuart, M. Papadakis, S. Sharma, A. Malhotra

Research output: Contribution to journalArticlepeer-review

2 Citations (SciVal)

Abstract

Introduction: Athletic training can result in electrical and structural changes of the right ventricle that may mimic phenotypical features of arrhythmogenic right ventricular cardiomyopathy (ARVC), such as T-wave inversion and right heart dilatation. An erroneous interpretation may have consequences ranging from false reassurance in an athlete vulnerable to cardiac arrhythmias, to unnecessary sports restriction in a healthy individual. The primary aim of this study was to define normal RV dimension reference ranges for academy adolescent footballers of different ethnicities. Secondary aims include analysis of potential overlap between this adolescent group with ARVC criteria and comparison with normal adult ranges. Results: Electrocardiographic (ECG) and echocardiographic data of 1087 academy male footballers aged between 13 and 18 years old (mean age 16.0 ± 0.5 years), attending mandatory cardiac screening were analysed. Ethnicity was categorised as white (n = 826), black (African/Caribbean; n = 166) and mixed-race (one parent white and one parent black; n = 95). Arrhythmogenic right ventricular cardiomyopathy major criteria for T-wave inversion was seen in 3.3% of the cohort. This was more prevalent in black footballers (12%) when compared to mixed race footballers (6.3%) or white footballers (1%), P < 0.05. Up to 59% of the cohort exceeded adult reference ranges for some of the right ventricular parameters, although values were similar to those seen in adult footballers. There were no differences in right ventricular dimensions between ethnicities. In particular, the right ventricular outflow tract diameter would fulfil major criteria for ARVC dimension in 12% of footballers. Overall, 0.2% of the cohort would fulfil diagnosis for ‘definite’ arrhythmogenic right ventricular cardiomyopathy and 2.2% would fulfil diagnosis for ‘borderline’ arrhythmogenic right ventricular cardiomyopathy for RV dimensions and ECG changes. This was seen more frequently in black footballers (9.9%) than mixed race footballers (3.9%) or white footballer (0.6%), P < 0.05. Among athletes meeting definite or borderline arrhythmogenic right ventricular cardiomyopathy criteria, no cardiomyopathy was identified after comprehensive clinical assessment, including with cardiac magnetic resonance imaging, exercise testing, ambulatory electrocardiograms and familial evaluation. Conclusion: Right heart sizes in excess of accepted adult ranges occurred in as many as one in two adolescent footballers. Structural adaptations in conjunction with anterior T-wave inversion may raise concern for ARVC, highlighting the need for evaluation in expert settings.

Original languageEnglish
Article number7
JournalEcho Research and Practice
Volume11
Issue number1
DOIs
Publication statusPublished - 29 Feb 2024

Data Availability Statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Funding

AM is funded by a Clinician Scientist Fellowship from the MRC (R127556). The authors thank The Football Association Cardiology Consensus panel and Cardiac Risk in the Young charity for support.

FundersFunder number
Football Association Cardiology Consensus panel
Medical Research CouncilR127556

Keywords

  • Athlete
  • Cardiomyopathy
  • Echocardiography
  • Exercise
  • Football
  • Sports cardiology

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Advanced and Specialised Nursing

Fingerprint

Dive into the research topics of 'Right ventricular assessment of the adolescent footballer’s heart'. Together they form a unique fingerprint.

Cite this