Marked ventricular repolarization abnormalities in highly trained athletes' electrocardiograms: Clinical and prognostic implications

OBJECTIVES We sought to study the functional, clinical and prognostic impli cations of marked repolarization abnormalities (MRA) sometimes seen in athl etes' electrocardiograms (ECGs). BACKGROUND The clinical meaning of ECG MRA in athletes is unknown. No relat ionship has been drawn between either training intensity or any particular type of sport and MRA. Athletes are usually symptom free and do not show an y decrease in their physical performance. It is as yet unclear whether MRA may have a negative effect on the performance of such athletes in competiti ve sports. METHODS We studied 26 athletes with MRA (negative T waves greater than or e qual to 2 mm in three or more ECG leads at rest). No athletes presented cli nical symptoms of cardiac disease or decrease in their physical performance . Clinical and physical examinations, ECG at rest, exercise test and echoca rdiographic and antimyosin studies were performed in all athletes. Rest/exe rcise myocardial perfusion single-photon emission computed tomography studi es were performed in 17 athletes. The follow-up ranged from 4 to 20 years ( mean 6.7 years). RESULTS Four athletes were excluded due to hypertrophic cardiomyopathy. Ech ocardiographic studies showed right and left normal ventricular dimensions for highly conditioned athletes. In the exercise test, heart rate was 166 /- 12.4 beats/min, and exercise tolerance was 15.2 +/- 2.7 metabolic equiva lents of the task. All athletes had ECG at rest simulating myocardial ische mia or "pseudoischemia" with a tendency to normalize during exercise. Myoca rdial perfusion studies were normal in the studied athletes. Antimyosin stu dies showed mild and diffuse myocardial radiotracer uptake in 15 athletes ( 68%). No adverse clinical events were observed in the follow-up. CONCLUSIONS These results suggest that MRA have no clinical or pathological implications in athletes and should, therefore, not preclude physical trai ning or participation in sporting events. (J Am Coll Cardiol 2000;36:1310-6 ) (C) 2000 by the American College of Cardiology.