Bambino Gesù Study: 9% of Young Athletes Have ECG Abnormalities

The electrocardiogram (ECG) for the release of competitive sports certification is an excellent screening tool for the early identification of any cardiomyopathies, or other pathologies, which can increase the risk of sudden death even in apparently healthy young athletes. A study by the Bambino Gesù pediatric hospital in Rome, published in the official journal of the European Society of Pediatric Cardiology (Cardiology in the Young), found the presence of anomalies in the electrocardiographic tracing for 9% of the approximately 600 children and teenagers examined. 3% of the very young athletes, after further investigation, were suspended from competitive activity as a precaution due to the cardiac problems found.

The ECG is a very simple and effective test – the hospital in Rome reminds us in a note – that records the electrical activity of the heart in the form of a graph, through a sequence of waves and straight segments. One of these waves – the T Wave – detects in particular the ventricular repolarization, or the ‘recharging time’ of the heart. Normally the shape of this Wave is positive, with the curve upwards compared to the horizontal axis of the graph. When it is negative, however, it can generally be an indicator of possible anomalies of the cardiac muscle (both in terms of muscle structure and regular blood perfusion). The presence of the negative T Wave in the screening electrocardiogram, therefore, or ‘T Wave Inversion’ (Wti), should be recorded as an anomaly of repolarization and can generate some suspicion even in very young and apparently healthy subjects, to the point of determining a contraindication to competitive sports. The evaluation protocols for sports fitness are very strict and in these cases require further investigations (echocardiogram, magnetic resonance imaging, cardiac CT scan) to arrive at a possible diagnosis or exclude an underlying heart disease.

Starting from these premises, doctors and researchers of the Sports Medicine of Bambino Gesù have promoted a study to evaluate the prevalence of repolarization anomalies (T wave inversion) in a population of young competitive athletes and determine whether these anomalies, detected by the ECG tracing, can be associated with the onset of cardiomyopathies in the absence of other pathological characteristics.

The research, carried out in collaboration with colleagues from the Advanced Cardiovascular and Thoracic Radiology and Cardiology and Arrhythmology departments of San Paolo, Palidoro and Santa Marinella, involved 581 young athletes – average age 15, 80% male – selected over 18 months for the evaluation of their suitability for competitive sports. For 53 of them (9%) anomalies were detected in the ECG trace linked to the presence of T-wave inversion (Wti). Subjected to further investigations (echocardiogram, Holter ECG, MRI or cardiac CT), 17 of them (3%) could not receive the suitability for competitive sports due to the cardiac pathologies found: 8 cardiomyopathies, 2 myocarditis, 5 myocardial bridges, 2 coronary anomalies. The other 36 athletes with Wti – in the absence of detected pathologies – obtained competitive fitness with the indication of frequent checks every 6-12 months.

“The probability that competitive athletes have a hidden cardiomyopathy is low, but not negligible. The electrocardiographic screening, preliminary to the eligibility for competitive sports – comments Ugo Giordano, head of the Sports Medicine Unit at Bambino Gesù – is therefore confirmed as an excellent opportunity to identify early cardiomyopathies and other pathologies that increase the risk of sudden death in apparently healthy young athletes. Any repolarization anomalies, signaled by the inversion of the T wave, must always be investigated and examined in depth by contacting specialized centers. In Italy, the evaluation protocols for access to competitive sports are rightly very rigorous. The specialist visit for the issue of eligibility includes a cardiological visit, an electrocardiogram at rest and under stress, a spirometric test and a urine test report. For non-competitive sports, although there is no obligation in this sense, the advice of sports doctors is to always perform an electrocardiogram at each visit for the issue of the certificate, in consideration of the fact that the electrocardiogram is always performed at each visit for the issue of the certificate. of its value as a health screening tool.”