TY - JOUR
T1 - Electrocardiographic Features Differentiating Arrhythmogenic Right Ventricular Cardiomyopathy From an Athlete's Heart
AU - Brosnan, Maria J.
AU - te Riele, Anneline S.J.M.
AU - Bosman, Laurens P.
AU - Hoorntje, Edgar T.
AU - van den Berg, Maarten P.
AU - Hauer, Richard N.W.
AU - Flannery, Michael D.
AU - Kalman, Jon M.
AU - Prior, David L.
AU - Tichnell, Crystal
AU - Tandri, Harikrishna
AU - Murray, Brittney
AU - Calkins, Hugh
AU - La Gerche, Andre
AU - James, Cynthia A.
N1 - Funding Information:
The Johns Hopkins ARVD/C Program is supported by the Dr. Francis P. Chiaramonte Private Foundation, the Leyla Erkan Family Fund for ARVD Research, the Dr. Satish, Rupal, and Robin Shah ARVD Fund at Johns Hopkins, the Bogle Foundation, the Healing Hearts Foundation, the Campanella family, the Patrick J. Harrison Family, the Peter French Memorial Foundation, and the Wilmerding Endowments. Dr. La Gerche is supported by a Career Development Fellowship from the National Health and Medical Research Council (NHMRC 1089039) and a Future Leaders Fellowship from the National Heart Foundation (NHF 100409) of Australia. Dr. te Riele is supported by the Dutch Heart Foundation (grant number 2015T58) and the University Medical Center Utrecht Fellowship Clinical Research Talent. Dr. Calkins is supported by the Leducq Foundation – RHYTHM Network. Dr. James is supported by the Netherlands Organisation for Scientific Research (NWO, visitor’s travel grant). Drs. te Riele, Bosman, Hoorntje, and van den Berg are supported by the Netherlands Cardiovascular Research Initiative, an initiative supported by the Netherlands Heart Foundation (CVON2012-10 PREDICT, CVON2014-40 DOSIS, and CVON2015-12 eDETECT). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Katja Zeppenfeld, MD, served as Guest Editor for this paper.
Publisher Copyright:
© 2018
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Objectives: This study sought to compare electrocardiogram (ECG) variants in athletic and arrhythmogenic right ventricular cardiomyopathy (ARVC) cohorts matched for the confounders of age, sex, and ethnicity. Background: Anterior T-wave inversion (TWIV1−V4) is a common electrocardiographic finding in both athletes and patients with ARVC, and is a frequent conundrum in the setting of pre-participation screening. J-point elevation (JPE) has been proposed as an accurate means of identifying athletes, whereas disease markers, including premature ventricular contractions (PVCs) and low-voltage signals, have been associated with ARVC. Methods: This study examined 200 subjects with TWI V1−V4, including 100 healthy athletes and 100 ARVC patients matched 1:1 for age, sex, and ethnicity (age: 21 ± 5 years for athletes vs. 22 ± 5 years for ARVC patients; 47% male; 97% Caucasian). The presence of TWI, JPE, PVCs, and left ventricular hypertrophy (LVH) were assessed. Results: JPE was observed in 27% of athletes versus 16% of ARVC patients (p = 0.09). Thus, JPE had poor specificity (27%) and accuracy (60%) in identifying healthy athletes. In contrast, ARVC patients demonstrated a greater prevalence of precordial TWI beyond lead V3 (34% vs. 8%; p < 0.001), inferior TWI (31% vs. 3%; p < 0.001), PVCs (18% vs. 0%; p < 0.001), and lower LVH scores (SV1 + RV5; 19 ± 1 mm vs. 30 ± 1 mm; p < 0.001). These combined factors provided more reliable differentiation between health and disease (specificity 82%, accuracy 81%). Conclusions: PVCs and low QRS voltages are more prevalent among ARVC patients than athletes, whereas JPE is a relatively poor discriminator of health and disease when the confounders of age, sex, and ethnicity are considered.
AB - Objectives: This study sought to compare electrocardiogram (ECG) variants in athletic and arrhythmogenic right ventricular cardiomyopathy (ARVC) cohorts matched for the confounders of age, sex, and ethnicity. Background: Anterior T-wave inversion (TWIV1−V4) is a common electrocardiographic finding in both athletes and patients with ARVC, and is a frequent conundrum in the setting of pre-participation screening. J-point elevation (JPE) has been proposed as an accurate means of identifying athletes, whereas disease markers, including premature ventricular contractions (PVCs) and low-voltage signals, have been associated with ARVC. Methods: This study examined 200 subjects with TWI V1−V4, including 100 healthy athletes and 100 ARVC patients matched 1:1 for age, sex, and ethnicity (age: 21 ± 5 years for athletes vs. 22 ± 5 years for ARVC patients; 47% male; 97% Caucasian). The presence of TWI, JPE, PVCs, and left ventricular hypertrophy (LVH) were assessed. Results: JPE was observed in 27% of athletes versus 16% of ARVC patients (p = 0.09). Thus, JPE had poor specificity (27%) and accuracy (60%) in identifying healthy athletes. In contrast, ARVC patients demonstrated a greater prevalence of precordial TWI beyond lead V3 (34% vs. 8%; p < 0.001), inferior TWI (31% vs. 3%; p < 0.001), PVCs (18% vs. 0%; p < 0.001), and lower LVH scores (SV1 + RV5; 19 ± 1 mm vs. 30 ± 1 mm; p < 0.001). These combined factors provided more reliable differentiation between health and disease (specificity 82%, accuracy 81%). Conclusions: PVCs and low QRS voltages are more prevalent among ARVC patients than athletes, whereas JPE is a relatively poor discriminator of health and disease when the confounders of age, sex, and ethnicity are considered.
KW - arrhythmogenic right ventricular cardiomyopathy
KW - athlete
KW - ECG
KW - pre-participation screening
KW - T-wave inversion
UR - https://www.scopus.com/pages/publications/85058056067
U2 - 10.1016/j.jacep.2018.09.008
DO - 10.1016/j.jacep.2018.09.008
M3 - Article
C2 - 30573127
AN - SCOPUS:85058056067
SN - 2405-500X
VL - 4
SP - 1613
EP - 1625
JO - JACC. Clinical electrophysiology
JF - JACC. Clinical electrophysiology
IS - 12
ER -