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Background: International electrocardiographic (ECG) recommendations regard anterior T-wave inversion (ATWI) in athletes under 16 years to be normal., Design: The aim of this study was to identify the prevalence, distribution and determinants of TWI by ethnicity, chronological and biological age within paediatric athletes. A second aim was to establish the diagnostic accuracy of international ECG recommendations against refinement within athletes who present with ECG variants isolated to ATWI (V 1 -V 4 ) using receiver operator curve analysis. Clinical context was calculated using Bayesian analysis., Methods: Four hundred and eighteen Arab and 314 black male athletes (11-18 years) were evaluated by ECG, echocardiogram and biological age (by radiological X-ray) assessment., Results: A total of 116 (15.8%) athletes presented with ATWI (V 1 -V 4 ), of which 96 (82.8%) were observed in the absence of other ECG findings considered to be abnormal as per international recommendations for ECG interpretation in athletes; 91 (12.4%) athletes presented with ATWI confined to V 1 -V 3 , with prevalence predicted by black ethnicity (odds ratio (OR) 2.2, 95% confidence interval (CI) 1.3-3.5) and biological age under 16 years (OR 2.0, 95% CI 1.2-3.3). Of the 96 with ATWI (V 1 -V 4 ) observed in the absence of other ECG findings considered to be abnormal, as per international recommendations for ECG interpretation in athletes, diagnostic accuracy was 'fail' (OR 0.47, 95% CI 0.00-1.00) for international recommendations and 'excellent' (OR 0.97, 95% CI 0.92-1.00) when governed by biological age under 16 years, providing a positive and negative likelihood ratio of 15.8 (95% CI 1.8-28.1) and 0.0 (95% CI 0.0-0.8), respectively., Conclusion: Interpretation of ECG variants isolated with ATWI (V 1 -V 4 ) using international recommendations (chronological age <16 years) warrants caution, but governance by biological age yielded an 'excellent' diagnostic accuracy. In the clinical context, the 'chance' of detecting cardiac pathology within a paediatric male athlete presenting with ATWI in the absence of other ECG findings considered to be abnormal, as per international recommendations for ECG interpretation in athletes (positive likelihood ratio 15.8), was 14.4%, whereas a negative ECG (negative likelihood ratio 0.0) was 0%.

Background: Vitamin D (25(OH)D) deficiency has associations with bowl/colon cancer, arthritis, diabetes, and cardiovascular disease. Many athletes are vitamin D deficient, yet no studies have examined the association between 25(OH)D status and cardiac structure and function in healthy athletes., Design: A total of 506 national-level athletes [football (50%), handball (23%), volleyball (16%), and basketball (11%)] and 244 control participants presented for precompetition medical assessment. Controls were healthy individuals registered with a sporting federation undertaking <2 h of exercise per week., Methods: All individuals undertook a physical examination, 12-lead electrocardiogram, echocardiogram, and serum 25(OH)D evaluation., Results: From 506 athletes and 244 controls, 23 and 12.3% demonstrated 25(OH)D sufficiency (>30 ng/ml), 30 and 23.4% insufficiency (20-30 ng/ml), 37.2 and 48.8% deficiency (10-20 ng/ml), and 11 and 15.6% severe deficiency (<10 ng/ml). Severely 25(OH)D-deficient athletes present significantly (p < 0.05) smaller aortic root and left atria diameters, intraventricular septum diameter (IVSd), left ventricular diameter during diastole (LVIDd), left ventricular mass (LVM), left ventricular volume during diastole (LVvolD), and right atrial (RA) area than insufficient and sufficient athletes. Furthermore, following logarithmic transformation adjusting 25(OH)D for age, body surface area, ethnicity, and athletic participation, positive associations were observed between 25(OH)D and IVSd, LVIDd, posterior wall thickness during diastole, LVM, and LVvolD in athletes but not in the control participants., Conclusions: Severely 25(OH)D-deficient athletes present significantly smaller cardiac structural parameters than insufficient and sufficient athletes. Future research should investigate the precise mechanism(s) causing cardiac hypertrophy with increases in serum 25(OH)D in healthy athletes., (© The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Background: The clinical and economic value of including systematic echocardiography (ECHO) alongside the 12-lead electrocardiograpm (ECG) when undertaking pre-participation screening in athletes has not been examined, yet several sporting organistations recommend its inclusion., Design: To examine the efficacy of systematic ECHO alongside the ECG, to identify sudden cardiac death (SCD) disease and to provide a cost-analysis of a government-funded pre-participation screening programme., Methods: A total 1628 athletes presented for cardiological consultation, ECG, and ECHO as standard, with further cardiac examinations performed if necessary to confirm or exclude pathology. The efficacy of systematic ECHO was compared to an ECG-led programme, with ECHO reserved as a follow-up examination., Results: To screen 1628 athletes with ECG and ECHO cost US$743,996. There were 54 24-h-blood pressure/ECG Holter recordings, 62 exercise tests, 25 CMRs, two electrophysiological studies, and two genetic tests, which cost US$67,734: total US$811,730. Eight athletes (0.5%) were identified with hypertrophic cardiomyopathy (HCM) and two (0.1%) with Wolff-Parkinson-White syndrome. The cost per identifed athlete was US$81,173. All 10 athletes presented an abnormal ECG. No athlete diagnosed with HCM was identified by ECHO in isolation. When adopting a ECG-led screening protocol, 15% of athletes required ECHO as a follow-up examination, resulting in a US$380,600 cost reduction (47% saving), with the cost per diagnosis reduced to US$43,113., Conclusions: Athletes diagnosed with a disease associated with SCD were identified via an abnormal ECG and/or physical examination, personal symptoms, or family history. Screening athletes with systematic ECHO is not economically or clinically effective., (© The European Society of Cardiology 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)