Relatıonshıp between hypertrophy crıterıa and dıastolıc dysfunctıon ın athlete electrocardıograms

Öz

Aim: Our study aims to investigate the predictive power of the Sokolow-Lyon criterion for left ventricular hypertrophy and left ventricular diastolic dysfunction and to compare it with other hypertrophy criteria. Material and Methods: Between January 2023 and January 2024, 121 professional athletes from Ankara Gaziler Physical Therapy and Rehabilitation Training and Research Hospital and 31 healthy volunteers from Bahçelievler Medipol Hospital were evaluated as participants. Data were obtained from electrocardiography and echocardiography examinations of the patients. Results: The mean age of the athlete group was 24.83 years and the control group was 28.81 years. Sokolow-Lyon voltage was significantly higher in the athletes (p=0.00). Left ventricular mass index was 81.66 g/m2 in the athlete group and 76.59 g/m2 in the control group and there was no significant difference between the groups (p=0.09). There was no difference between the groups in terms of left ventricular geometry change and diastolic dysfunction. Sokolow-Lyon voltage of ≥35 mm was not associated with abnormal geometry, left ventricular mass and diastolic dysfunction. Conclusion: Considering the limited sensitivity of the Sokolow-Lyon criterion in predicting hypertrophy in athletes, it is emphasized that more comprehensive evaluations should be considered in the evaluation of athlete ECGs. Furthermore, assessment of left ventricular geometry is important in differentiating pathologic conditions. Most of the cardiac changes seen in athletes

Anahtar Kelimeler

• Athlete
• Diastolic dysfunction
• Electrocardiography
• Sokolow-Lyon criteria

Sporcu elektrokardiyogramlarında hipertrofi kriterlerinin diyastolik disfonksiyon ilişkisi

Öz

Amaç: Çalışmamız ile öncelikle Sokolow-Lyon kriterinin sol ventrikül hipertrofisi ve sol ventrikül diyastolik disfonksiyonu öngördürücülüğü araştırılacaktır ve diğer hipertrofi kriterleri ile karşılaştırılacaktır. Gereç ve Yöntemler: Ocak 2023 ve Ocak 2024 tarihleri Ankara Gaziler Fizik Tedavi ve Rehabilitasyon Eğitim ve Araştırma Hastanesi'nden 121 profesyonel sporcu ile Bahçelievler Medipol Hastanesi'nden 31 sağlıklı gönüllü katılımcı olarak değerlendirilmiştir. Hastaların elektrokardiyografi ve ekokardiyografi tetkiklerinden veriler elde edilmiştir. Bulgular: Sporcu grubunun yaş ortalaması 24,83 yıl ve kontrol grubu 28,81 yıl olarak hesaplandı. Sokolow-Lyon voltajı sporcularda anlamlı olarak daha yüksek bulundu. Sol ventrikül kitle indeksi sporcu grubunda 81,66 g/m2 ve kontrol grubunda 76,59 g/m2 olarak ölçüldü gruplar arasında anlamlı fark yoktu(p=0,09). Sol ventrikül geometri değişikliği ve diyastolik disfonksiyon açısından gruplar arasında fark saptanmadı. Sokolow-Lyon voltajının ≥35 mm olması normal dışı geometri, sol ventrikül kitlesi ve diyastolik disfonksiyon ile ilişkili bulunmadı. Sonuç: Sokolow-Lyon kriterinin sporcularda hipertrofiyi öngörmedeki sınırlı duyarlılığı göz önünde bulundurularak, sporcu EKG’lerinin değerlendirilmesinde daha kapsamlı değerlendirmelerin dikkate alınması gerektiği vurgulanmıştır. Ayrıca, sol ventrikül geometrisinin değerlendirilmesi, patolojik durumların ayrımında önem taşımaktadır. Sporcularda görülen kalp değişikliklerinin büyük ölçüde fizyolojik adaptasyon olduğu sonucuna varılmıştır.

Anahtar Kelimeler

• Diyastolik disfonksiyon
• Elektrokardiyografi
• Sokolow-Lyon kriteri
• Sporcu

Kaynakça

1. Malmgren, A., et al., Electrocardiographic manifestations in female team handball players: analyzing ECG changes in athletes. Frontiers in Sports and Active Living, 2024. 6: p. 1384483.
2. Bacharova, L., ECG in left ventricular hypertrophy: A change in paradigm from assessing left ventricular mass to its electrophysiological properties. Journal of Electrocardiology, 2022. 73: p. 153-156.
3. Finocchiaro, G., et al., Effect of sex and sporting discipline on LV adaptation to exercise. JACC: Cardiovascular Imaging, 2017. 10(9): p. 965-972.
4. Eun, L.Y. and H.W. Chae, Assessment of myocardial function in elite athlete’s heart at rest-2D speckle tracking echocardiography in Korean elite soccer players. Scientific Reports, 2016. 6(1): p. 39772.
5. Siranart, N., et al., Diagnostic accuracy of artificial intelligence in detecting left ventricular hypertrophy by electrocardiograph: a systematic review and meta-analysis. Scientific Reports, 2024. 14(1): p. 15882.
6. Rabkin, S.W. and J.C.J. Zhou, Estimating Left Ventricular Mass from the Electrocardiogram across the Spectrum of LV Mass from Normal to Increased LV Mass in an Older Age Group. Cardiology Research and Practice, 2024. 2024(1): p. 6634222.
7. Nagueh, S.F., et al., Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Journal of Echocardiography, 2016. 17(12): p. 1321-1360.
8. Dalen, H., et al., Diastolic function and dysfunction in athletes. European Heart Journal-Cardiovascular Imaging, 2024. 25(11): p. 1537-1545.

9. A Alrudainy, L., O. S Habib, and A. Raheem AL-Humrani, VALIDITY OF ELECTROCARDIOGRAPHIC VOLTAGE CRITERIA: HOW USEFUL ARE THEY IN ATHLETES? The Medical Journal of Basrah University, 2005. 23(2): p. 21-25.
10. Weiss, M., et al., Physician adherence to ‘Seattle’and ‘International’ECG criteria in adolescent athletes: an analysis of compliance by specialty, experience, and practice environment. Journal of Electrocardiology, 2020. 60: p. 98-101.
11. Smaranda, A.M., et al., Artificial intelligence in sports medicine: reshaping electrocardiogram analysis for athlete safety—a narrative review. Sports, 2024. 12(6): p. 144.
12. Kurtoğlu, A., et al., Comparison of echocardiographic parameters of amputee football players with active football players and sedentary individuals. BMC Sports Science, Medicine and Rehabilitation, 2023. 15(1): p. 41.
13. Pambo, P., et al., Electrocardiographic and echocardiographic findings in elite Ghanaian male soccer players. Clinical Journal of Sport Medicine, 2021. 31(6): p. e373-e379.
14. Yang, P., et al., Evaluation of the electrocardiogram RV5/V6 criteria in the diagnosis of left ventricular hypertrophy in marathon runners. The Journal of Clinical Hypertension, 2023. 25(7): p. 638-646.
15. Caselli, S., et al., Differentiating left ventricular hypertrophy in athletes from that in patients with hypertrophic cardiomyopathy. The American journal of cardiology, 2014. 114(9): p. 1383-1389.
16. Pelliccia, A., et al., 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease: The Task Force on sports cardiology and exercise in patients with cardiovascular disease of the European Society of Cardiology (ESC). European heart journal, 2021. 42(1): p. 17-96.
17. Maron, B.J. and A. Pelliccia, The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation, 2006. 114(15): p. 1633-1644.
18. Sjúrðarson, T., et al., 15 weeks of soccer training increases left ventricular mass and improves indices of left ventricular diastolic function in previously sedentary, mildly hypertensive, middle-aged women. European Journal of Applied Physiology, 2024. 124(5): p. 1621-1629.