Electrocardiographic and Echocardiographic findings in Ghanaian Soccer Players

Abstract

Introduction: Participation in regular sports elicits various electrophysiological and structural cardiac changes which can be seen on athletes’ electrocardiogram (ECG) and echocardiography (ECHO), and collectively known as ‘athlete’s heart’. While commonly falling within the defined limits of physiological normality, these cardiac adaptations can sometimes lead to a diagnostic dilemma for the practicing sports physician where they may overlap with the phenotypic expression of pathology. These physiological adaptations complicate the differentiation of sinister cardiac disorders implicated in sudden cardiac death (SCD) which is more prevalent among black athletes than Caucasians. The aim of this study was to examine the electrocardiographic and echocardiographic tracings in Ghanaian (West Africans) male and female soccer players playing for the various National and premier soccer teams and to describe typical ECG and ECHO findings in this cohort. We believe data from this study will contribute to the development of a race sensitive ECG and ECHO interpretation criteria, hence minimizing the need for further investigations and unfair disqualification of this ethnic group. Methods: In this cross-sectional study, subjects were current players of Ghanaian male and female national soccer teams, aged between 14 and 27 years and preparing for various international football tournaments. Players with any cardiovascular disease were excluded from the study. The players have been involved in competitive soccer playing averagely six and ten years for the adolescents and adults respectively. They usually train six days every week, with each session lasting averagely 2 hours. As part of preparations for tournaments, all players had to go through a mandatory pre-competition medical assessment which included cardiac screening (12- lead ECG and 2-dimensional ECHO). A total of 289 male and female soccer players who are all Ghanaians (black west Africans) went through the screening. Our participants were made up of 139 adults and 150 adolescents. All ECGs and ECHOs were analysed independently by experienced investigators. Results: Thirty male players representing 16% of the male participants had abnormal ECGs made up of inverted T- waves in lateral leads, deep T-wave inversion, long and short QT intervals and ST segment depression. About 11% of our female subjects had abnormal ECGs. About 8% and 9% of males and females respectively had T-wave inversions (TWI) in lateral leads (V5-V6). Voltage criteria for left ventricular hypertrophy (LVH) was respectively present in 67% and 28% of our male and female participants. Whilst 33% of our male players had LV wall thickness (LVWT) ranging from 12 mm to 15mm, only three players had LVWT of 16mm with no player exceeding 16 mm. About 10% of female players had LVWT greater than 11 mm with no female player exceeding 13 mm. LV cavity dimension greater than 60 mm and 54 mm was respectively present in 4% of males and 7% of female players. Conclusion: Uncommon/training-unrelated ECG changes such as complete right bundle branch block, TWI in lateral leads and deep TWI, were more prevalent among both male and female Ghanaian soccer players compared to Caucasian and west Asian athletes, suggesting a combination of athletic training and black ethnicity or geographic origin may be responsible for such exaggerated cardiovascular responses. From our findings the presence ST segment depression or deep T- wave inversions in lateral leads with associated LV wall thickness greater than 15 mm and 12 mm in males and female players respectively, is unlikely to be a normal physiological response and therefore warrants further investigation to rule out any cardiomyopathy. We can also conclude from our study and other studies that stark differences do exist in the way the hearts of black African athletes originating from different geographic locations within Africa respond to the impact of chronic exercises or athletic training. The phrase “Black African athlete’s heart” should therefore not be simply taken as representative of the hearts of all black African athletes.