Electrocardiographic findings in national basketball association athletes

Marc P. Waase, R Kannan Mutharasan, William Whang, Marco R. DiTullio, John P. DiFiori, Lisa Callahan, Jimmie Mancell, Dermot Phelan, Allan Schwartz, Shunichi Homma, David J. Engel*

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

IMPORTANCE While it is known that long-Term intensive athletic training is associated with cardiac structural changes that can be reflected on surface electrocardiograms (ECGs), there is a paucity of sport-specific ECG data. This study seeks to clarify the applicability of existing athlete ECG interpretation criteria to elite basketball players, an athlete group shown to develop significant athletic cardiac remodeling. OBJECTIVE To generate normative ECG data for National Basketball Association (NBA) athletes and to assess the accuracy of athlete ECG interpretation criteria in this population. DESIGN, SETTING, AND PARTICIPANTS The NBA has partnered with Columbia University Medical Center to annually perform a review of policy-mandated annual preseason ECGs and stress echocardiograms for all players and predraft participants. This observational study includes the preseason ECG examinations of NBA athletes who participated in the 2013-2014 and 2014-2015 seasons, plus all participants in the 2014 and 2015 NBA predraft combines. Examinations were performed from July 2013 to May 2015. Data analysis was performed between December 2015 and March 2017. EXPOSURES Active roster or draft status in the NBA and routine preseason ECGs and echocardiograms. MAIN OUTCOMES AND MEASURES Baseline quantitative ECG variableswere measured and ECG data qualitatively analyzed using 3 existing, athlete-specific interpretation criteria: Seattle (2012), refined (2014), and international (2017). Abnormal ECG findings were compared with matched echocardiographic data. RESULTS Of 519 male athletes, 409 (78.8%) were African American, 96 (18.5%) were white, and the remaining 14 (2.7%) were of other races/ethnicities; 115 were predraft combine participants, and the remaining 404 were on active rosters of NBA teams. The mean (SD) age was 24.8 (4.3) years. Physiologic, training-related changes were present in 462 (89.0%) athletes in the study. Under Seattle criteria, 131 (25.2%) had abnormal findings, compared with 108 (20.8%) and 81 (15.6%) under refined and international criteria, respectively. Increased age and increased left ventricular relative wall thickness (RWT) on echocardiogram were highly associated with abnormal ECG classifications; 17 of 186 athletes (9.1%) in the youngest age group (age 18-22 years) had abnormal ECGs compared with 36 of the 159 athletes (22.6%) in the oldest age group (age 27-39 years) (odds ratio, 2.9; 95%CI, 1.6-5.4; P < .001). Abnormal T-wave inversions (TWI) were present in 32 athletes (6.2%), and this was associated with smaller left ventricular cavity size and increased RWT. One of the 172 athletes (0.6%) in the lowest RWT group (range, 0.24-0.35) had TWIs compared with 24 of the 163 athletes (14.7%) in the highest RWT group (range, 0.41-0.57) (odds ratio, 29.5; 95%CI, 3.9-221.0; P < .001). CONCLUSIONS AND RELEVANCE Despite the improved specificity of the international recommendations over previous athlete-specific ECG criteria, abnormal ECG classification rates remain high in NBA athletes. The development of left ventricular concentric remodeling appears to have a significant influence on the prevalence of abnormal ECG classification and repolarization abnormalities in this athlete group.

Original languageEnglish (US)
Pages (from-to)69-74
Number of pages6
JournalJAMA cardiology
Volume3
Issue number1
DOIs
StatePublished - Jan 1 2018

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Basketball
Athletes
Electrocardiography
Sports
Age Groups
Odds Ratio
Ventricular Remodeling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Waase, M. P., Mutharasan, R. K., Whang, W., DiTullio, M. R., DiFiori, J. P., Callahan, L., ... Engel, D. J. (2018). Electrocardiographic findings in national basketball association athletes. JAMA cardiology, 3(1), 69-74. https://doi.org/10.1001/jamacardio.2017.4572
Waase, Marc P. ; Mutharasan, R Kannan ; Whang, William ; DiTullio, Marco R. ; DiFiori, John P. ; Callahan, Lisa ; Mancell, Jimmie ; Phelan, Dermot ; Schwartz, Allan ; Homma, Shunichi ; Engel, David J. / Electrocardiographic findings in national basketball association athletes. In: JAMA cardiology. 2018 ; Vol. 3, No. 1. pp. 69-74.
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abstract = "IMPORTANCE While it is known that long-Term intensive athletic training is associated with cardiac structural changes that can be reflected on surface electrocardiograms (ECGs), there is a paucity of sport-specific ECG data. This study seeks to clarify the applicability of existing athlete ECG interpretation criteria to elite basketball players, an athlete group shown to develop significant athletic cardiac remodeling. OBJECTIVE To generate normative ECG data for National Basketball Association (NBA) athletes and to assess the accuracy of athlete ECG interpretation criteria in this population. DESIGN, SETTING, AND PARTICIPANTS The NBA has partnered with Columbia University Medical Center to annually perform a review of policy-mandated annual preseason ECGs and stress echocardiograms for all players and predraft participants. This observational study includes the preseason ECG examinations of NBA athletes who participated in the 2013-2014 and 2014-2015 seasons, plus all participants in the 2014 and 2015 NBA predraft combines. Examinations were performed from July 2013 to May 2015. Data analysis was performed between December 2015 and March 2017. EXPOSURES Active roster or draft status in the NBA and routine preseason ECGs and echocardiograms. MAIN OUTCOMES AND MEASURES Baseline quantitative ECG variableswere measured and ECG data qualitatively analyzed using 3 existing, athlete-specific interpretation criteria: Seattle (2012), refined (2014), and international (2017). Abnormal ECG findings were compared with matched echocardiographic data. RESULTS Of 519 male athletes, 409 (78.8{\%}) were African American, 96 (18.5{\%}) were white, and the remaining 14 (2.7{\%}) were of other races/ethnicities; 115 were predraft combine participants, and the remaining 404 were on active rosters of NBA teams. The mean (SD) age was 24.8 (4.3) years. Physiologic, training-related changes were present in 462 (89.0{\%}) athletes in the study. Under Seattle criteria, 131 (25.2{\%}) had abnormal findings, compared with 108 (20.8{\%}) and 81 (15.6{\%}) under refined and international criteria, respectively. Increased age and increased left ventricular relative wall thickness (RWT) on echocardiogram were highly associated with abnormal ECG classifications; 17 of 186 athletes (9.1{\%}) in the youngest age group (age 18-22 years) had abnormal ECGs compared with 36 of the 159 athletes (22.6{\%}) in the oldest age group (age 27-39 years) (odds ratio, 2.9; 95{\%}CI, 1.6-5.4; P < .001). Abnormal T-wave inversions (TWI) were present in 32 athletes (6.2{\%}), and this was associated with smaller left ventricular cavity size and increased RWT. One of the 172 athletes (0.6{\%}) in the lowest RWT group (range, 0.24-0.35) had TWIs compared with 24 of the 163 athletes (14.7{\%}) in the highest RWT group (range, 0.41-0.57) (odds ratio, 29.5; 95{\%}CI, 3.9-221.0; P < .001). CONCLUSIONS AND RELEVANCE Despite the improved specificity of the international recommendations over previous athlete-specific ECG criteria, abnormal ECG classification rates remain high in NBA athletes. The development of left ventricular concentric remodeling appears to have a significant influence on the prevalence of abnormal ECG classification and repolarization abnormalities in this athlete group.",
author = "Waase, {Marc P.} and Mutharasan, {R Kannan} and William Whang and DiTullio, {Marco R.} and DiFiori, {John P.} and Lisa Callahan and Jimmie Mancell and Dermot Phelan and Allan Schwartz and Shunichi Homma and Engel, {David J.}",
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Waase, MP, Mutharasan, RK, Whang, W, DiTullio, MR, DiFiori, JP, Callahan, L, Mancell, J, Phelan, D, Schwartz, A, Homma, S & Engel, DJ 2018, 'Electrocardiographic findings in national basketball association athletes', JAMA cardiology, vol. 3, no. 1, pp. 69-74. https://doi.org/10.1001/jamacardio.2017.4572

Electrocardiographic findings in national basketball association athletes. / Waase, Marc P.; Mutharasan, R Kannan; Whang, William; DiTullio, Marco R.; DiFiori, John P.; Callahan, Lisa; Mancell, Jimmie; Phelan, Dermot; Schwartz, Allan; Homma, Shunichi; Engel, David J.

In: JAMA cardiology, Vol. 3, No. 1, 01.01.2018, p. 69-74.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Electrocardiographic findings in national basketball association athletes

AU - Waase, Marc P.

AU - Mutharasan, R Kannan

AU - Whang, William

AU - DiTullio, Marco R.

AU - DiFiori, John P.

AU - Callahan, Lisa

AU - Mancell, Jimmie

AU - Phelan, Dermot

AU - Schwartz, Allan

AU - Homma, Shunichi

AU - Engel, David J.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - IMPORTANCE While it is known that long-Term intensive athletic training is associated with cardiac structural changes that can be reflected on surface electrocardiograms (ECGs), there is a paucity of sport-specific ECG data. This study seeks to clarify the applicability of existing athlete ECG interpretation criteria to elite basketball players, an athlete group shown to develop significant athletic cardiac remodeling. OBJECTIVE To generate normative ECG data for National Basketball Association (NBA) athletes and to assess the accuracy of athlete ECG interpretation criteria in this population. DESIGN, SETTING, AND PARTICIPANTS The NBA has partnered with Columbia University Medical Center to annually perform a review of policy-mandated annual preseason ECGs and stress echocardiograms for all players and predraft participants. This observational study includes the preseason ECG examinations of NBA athletes who participated in the 2013-2014 and 2014-2015 seasons, plus all participants in the 2014 and 2015 NBA predraft combines. Examinations were performed from July 2013 to May 2015. Data analysis was performed between December 2015 and March 2017. EXPOSURES Active roster or draft status in the NBA and routine preseason ECGs and echocardiograms. MAIN OUTCOMES AND MEASURES Baseline quantitative ECG variableswere measured and ECG data qualitatively analyzed using 3 existing, athlete-specific interpretation criteria: Seattle (2012), refined (2014), and international (2017). Abnormal ECG findings were compared with matched echocardiographic data. RESULTS Of 519 male athletes, 409 (78.8%) were African American, 96 (18.5%) were white, and the remaining 14 (2.7%) were of other races/ethnicities; 115 were predraft combine participants, and the remaining 404 were on active rosters of NBA teams. The mean (SD) age was 24.8 (4.3) years. Physiologic, training-related changes were present in 462 (89.0%) athletes in the study. Under Seattle criteria, 131 (25.2%) had abnormal findings, compared with 108 (20.8%) and 81 (15.6%) under refined and international criteria, respectively. Increased age and increased left ventricular relative wall thickness (RWT) on echocardiogram were highly associated with abnormal ECG classifications; 17 of 186 athletes (9.1%) in the youngest age group (age 18-22 years) had abnormal ECGs compared with 36 of the 159 athletes (22.6%) in the oldest age group (age 27-39 years) (odds ratio, 2.9; 95%CI, 1.6-5.4; P < .001). Abnormal T-wave inversions (TWI) were present in 32 athletes (6.2%), and this was associated with smaller left ventricular cavity size and increased RWT. One of the 172 athletes (0.6%) in the lowest RWT group (range, 0.24-0.35) had TWIs compared with 24 of the 163 athletes (14.7%) in the highest RWT group (range, 0.41-0.57) (odds ratio, 29.5; 95%CI, 3.9-221.0; P < .001). CONCLUSIONS AND RELEVANCE Despite the improved specificity of the international recommendations over previous athlete-specific ECG criteria, abnormal ECG classification rates remain high in NBA athletes. The development of left ventricular concentric remodeling appears to have a significant influence on the prevalence of abnormal ECG classification and repolarization abnormalities in this athlete group.

AB - IMPORTANCE While it is known that long-Term intensive athletic training is associated with cardiac structural changes that can be reflected on surface electrocardiograms (ECGs), there is a paucity of sport-specific ECG data. This study seeks to clarify the applicability of existing athlete ECG interpretation criteria to elite basketball players, an athlete group shown to develop significant athletic cardiac remodeling. OBJECTIVE To generate normative ECG data for National Basketball Association (NBA) athletes and to assess the accuracy of athlete ECG interpretation criteria in this population. DESIGN, SETTING, AND PARTICIPANTS The NBA has partnered with Columbia University Medical Center to annually perform a review of policy-mandated annual preseason ECGs and stress echocardiograms for all players and predraft participants. This observational study includes the preseason ECG examinations of NBA athletes who participated in the 2013-2014 and 2014-2015 seasons, plus all participants in the 2014 and 2015 NBA predraft combines. Examinations were performed from July 2013 to May 2015. Data analysis was performed between December 2015 and March 2017. EXPOSURES Active roster or draft status in the NBA and routine preseason ECGs and echocardiograms. MAIN OUTCOMES AND MEASURES Baseline quantitative ECG variableswere measured and ECG data qualitatively analyzed using 3 existing, athlete-specific interpretation criteria: Seattle (2012), refined (2014), and international (2017). Abnormal ECG findings were compared with matched echocardiographic data. RESULTS Of 519 male athletes, 409 (78.8%) were African American, 96 (18.5%) were white, and the remaining 14 (2.7%) were of other races/ethnicities; 115 were predraft combine participants, and the remaining 404 were on active rosters of NBA teams. The mean (SD) age was 24.8 (4.3) years. Physiologic, training-related changes were present in 462 (89.0%) athletes in the study. Under Seattle criteria, 131 (25.2%) had abnormal findings, compared with 108 (20.8%) and 81 (15.6%) under refined and international criteria, respectively. Increased age and increased left ventricular relative wall thickness (RWT) on echocardiogram were highly associated with abnormal ECG classifications; 17 of 186 athletes (9.1%) in the youngest age group (age 18-22 years) had abnormal ECGs compared with 36 of the 159 athletes (22.6%) in the oldest age group (age 27-39 years) (odds ratio, 2.9; 95%CI, 1.6-5.4; P < .001). Abnormal T-wave inversions (TWI) were present in 32 athletes (6.2%), and this was associated with smaller left ventricular cavity size and increased RWT. One of the 172 athletes (0.6%) in the lowest RWT group (range, 0.24-0.35) had TWIs compared with 24 of the 163 athletes (14.7%) in the highest RWT group (range, 0.41-0.57) (odds ratio, 29.5; 95%CI, 3.9-221.0; P < .001). CONCLUSIONS AND RELEVANCE Despite the improved specificity of the international recommendations over previous athlete-specific ECG criteria, abnormal ECG classification rates remain high in NBA athletes. The development of left ventricular concentric remodeling appears to have a significant influence on the prevalence of abnormal ECG classification and repolarization abnormalities in this athlete group.

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