New evidence in cardiovascular and geriatric medicine

A case–control study was performed to investigate if ECG alterations recorded in young trained athletes may constitute an early indication of silent cardiac disease carrying long term potentially serious effects. By using a database of 12,550 trained athletes 81 individuals with diffused repolarization abnormalities were identified: they showed deep inverted T waves (≥2 mm in more than two derivations) without clinically manifest cardiac disease. These athletes had performed periodical clinical controls, ECG and echocardiography in the course of an average period of 9 ± 7 years of observation. They were compared with 229 control athletes not showing ECG alterations. The results of this case–control study indicate that in 5 out of 81 athletes (around 6%) with ECG abnormalities a cardiomiopathy was diagnosed, and one sudden death case (at the age of 24 years) was recorded because of right ventricle arrhythmogenic dysplasia. Three out of the five athletes presented hypertrophic cardiomiopathy (at the age of 27, 32 and 50) after a period of 12 ± 5 years. The fifth athlete presented dilatative cardiomiopathy after 9 years of follow-up. None of the 229 athletes with normal ECG presented cardiac events and none diagnosed with cardiomiopathy nine (±3) years from the beginning of the evaluation (P = 0.001). Electrocardiographic abnormalities recordable in trained young apparently healthy athletes may constitute an early indication of underlying cardiomiopathies, particularly challenging in that they may remain silent for many years. Athletes showing ECG alterations should therefore undergo strict and continuous clinical monitoring through time.