Circulation, Vol 53, 286-291, Copyright © 1976 by American Heart Association
WR Roeske, RA O'Rourke, A Klein, G Leopold and JS Karliner
Athletes often exhibit ECG findings which are considered to be abnormal.
Therefore, we used noninvasive graphic methods to study 42 active
professional male basketball players, ranging in age from 21 to 31 years,
without clinically evident heart disease. Of the 42, 11 (25%) met the
Romhilt-Estes ECG voltage criteria for left ventricular hypertrophy, and 12
(29%) satisfied VCG criteria for left ventricular enlargement; nine (21%)
had left ventricular hypertrophy by both methods. In 33 subjects (79%) the
0.04 sec vector in the horizontal plane was anterior, and 29 of these
exhibited one or more standard criteria for right ventricular enlargement;
the ECG and VCG were concordant for right ventricular hypertrophy in 16
subjects (38%). Submaximal treadmill exercise tests (Bruce protocol) were
normal in eight athletes, while in one subject ventricular premature beats
occurred during the test. In 24 of 25 athletes (96%) from whom
phonocardiograms were obtained a third heart sound was recorded, while in
14 (56%), a fourth heart sound was present. Of the 14 athletes who had a
fourth heart sound, 12 (86%) had either ECG or VCG evidence of ventricular
hypertrophy. Only four of 23 athletes had an increased cardiothoracic ratio
(greater than .50) on routine chest X-ray. Ten athletes and ten control
subjects matched for height, weight and body surface area had
echocardiograms satisfactory for analysis. The left ventricular
end-diastolic dimension in the athletes averaged 53.7 +/- 1.3 (SE) mm
compared with a value of 49.9 +/- 0.7 mm in the control subjects (P less
than 0.02), and was increased (greater than or equal to 56 mm) in four.
Left ventricular posterior wall thickness averaged 11.1 +/- 0.6 mm,
compared with a value of 9.8 +/- 0.5 mm in the control subjects (P less
than 0.05), and was increased (greater than or equal to 11 mm) in six
athletes. The right ventricular end-diastolic dimension averaged 20.8 +/-
1.1 mm compared with a value of 12.9 +/- 2.2 mm in the controls (P less
than 0.004), and was increased (greater than or equal to 23 mm) in four
athletes. No athlete or control subject exhibited paradoxical septal
motion. In the athletes, ejection fraction (cube method) averaged 79 +/-
2.0% and mean Vcf averaged 1.13 +/- 0.04 circ/sec; these values did not
differ from those of the control subjects. Thus, both right and left
ventricular enlargement ("physiological hypertrophy") are often present in
the well-trained athlete, but left ventricular performance remains normal
in the basal state in such individuals. We condlude that these individuals
represent a selected subgroup of subjects who are variants of normal.
ARTICLES
Noninvasive evaluation of ventricular hypertrophy in professional athletes
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