Electrical Cardiac Remodeling in Triathletes: A Comparative Study in Elite Male and Female Athletes

Authors: Lingxia Li, Frédéric Schnell, Thibault Lachard, Anne-Charlotte Dupont, Shuzhe Ding, Solène Le Douairon Lahaye

Abstract:

Prolonged intensive endurance exercise is associated with cardiovascular adaptations in athletes. However, the sex differences in electrocardiographic (ECG) performance in triathletes are poorly understood. ECG results of male and female triathletes registered on the French ministerial lists of high-level athletes between 2015 and 2021 were involved. The ECG was evaluated according to commonly accepted criteria. 86 triathletes (50 male, 36 female) participated, with an average age of 19.9 ± 4.8 years. The training volume was 21 ± 6 hours per week in males and 19 ± 6 hours per week in females (p > 0.05). Despite the relatively larger P wave (96.0 ± 12.0 vs. 89.9 ± 11.5 ms, p = 0.02) and longer QRS complex (96.6 ± 11.1 vs. 90.3 ± 8.6 ms, p = 0.005) in males than in females, all indicators were within normal ranges in both sexes. The most common electrical manifestations were early repolarization (46.5%) and incomplete right bundle branch block (39.5%). No difference was found between sexes in electrical manifestations (p > 0.05). All ECG patterns were within normal limits under similar training volumes, but male triathletes were more susceptible to cardiovascular changes than females. The most common ECG manifestations in triathletes were early repolarization and incomplete right bundle branch block, with no disparity between males and females. Large samples involving both sexes are required.

Keywords: Cardiovascular remodeling, electrocardiography, triathlon, elite athletes.

References:

[1] La Gerche A, Wasfy M M, Brosnan M.J, Claessen G, Fatkin D, Heidbuchel H, et al. The Athlete's Heart-Challenges and Controversies: JACC Focus Seminar 4/4. Journal of the American College of Cardiology, 2022. 80(14): p. 1346-1362. https://doi.org/10.1016/j.jacc.2022.07.014
[2] Weiner RB, Baggish AL. Exercise-induced cardiac remodeling. Progress In Cardiovascular Diseases, 2012. 54(5): p. 380-386. https://doi.org/10.1016/j.pcad.2012.01.006
[3] Knechtle BP, Knechtle P, Lepers R. Participation and performance trends in ultra-triathlons from 1985 to 2009. Scandinavian Journal of Medicine & Science in Sports, 2011. 21(6): p. e82-e90. https://doi.org/10.1111/j.1600-0838.2010.01160.x
[4] Etxebarria N, Mujika I, and Pyne DB. Training and Competition Readiness in Triathlon. Sports (Basel, Switzerland), 2019. 7(5). https://doi.org/10.3390/sports7050101
[5] Dawkins TG, Shave RE, Baggish AL, Drane AL, Parisi EJ, Roberts MG, et al. Electrocardiographic changes following six months of long-distance triathlon training in previously recreationally active individuals. European Journal of Sport Science, 2020. 20(4): p. 553-562. https://doi.org/10.1080/17461391.2019.1641556
[6] Whyte GP, George K, Sharma S, Lumley S, Gates P, Prasad K, et al. Cardiac fatigue following prolonged endurance exercise of differing distances. Medicine and Science in Sports and Exercise, 2000. 32(6): p. 1067-1072. https://doi.org/10.1097/00005768-200006000-00005
[7] Warburton DER, Welsh RC, Haykowsky MJ, Taylor DA, Humen DP, Dzavik V. Effects of half ironman competition on the development of late potentials. Medicine and Science in Sports and Exercise, 2000. 32(7): p. 1208-1213. https://doi.org/10.1097/00005768-200007000-00004
[8] Leetmaa TH, Dam A, Glintborg D, Markenvard JD. Myocardial response to a triathlon in male athletes evaluated by Doppler tissue imaging and biochemical parameters. Scandinavian Journal of Medicine & Science in Sports, 2008. 18(6): p. 698-705. https://doi.org/10.1111/j.1600-0838.2007.00647.x
[9] Sharma S, Drezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, et al. International recommendations for electrocardiographic interpretation in athletes. European Heart Journal, 2018. 39(16): p. 1466-1480. https://doi.org/10.1093/eurheartj/ehw631
[10] Corrado D, Pelliccia A, Heidbuchel H, Sharma S, Link M, Basso C, et al. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. European Heart Journal, 2010. 31(2): p. 243-259. https://doi.org/10.1093/eurheartj/ehp473
[11] Sharma S. and Accame MM. Cardiovascular Adaptations in Triathlon. Triathlon Medicine, 2020: p. 159-171.
[12] Hosatte‐Ducassy C, Correa JA, Lalonde F, Mohindra R, Marton G, Chetrit M, et al. Electrocardiographic changes after completion of a triathlon. Translational Sports Medicine, 2020. 3(3): p. 196-203.
[13] Pelliccia A, Maron BJ, Culasso F, Di Paolo FM, Spataro A, Biffi A, et al. Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation, 2000. 102(3): p. 278-284. https://doi.org/10.1161/01.cir.102.3.278
[14] Lasocka-Koriat, Z., et al., Differences in cardiac adaptation to exercise in male and female athletes assessed by noninvasive techniques: a state-of-the-art review. American Journal of Physiology. Heart and Circulatory Physiology, 2024. 326(5): p. H1065-H1079.
[15] Metsios GS, Wyon M, Patel K, Allen N, Koutedakis Y. Dancers' heart: Cardiac screening in elite dancers. European Journal of Sport Science, 2020. 20(7): p. 920-925. https://doi.org/10.1080/17461391.2019.1672793
[16] Bessem B, de Bruijn MC, Nieuwland W. Gender differences in the electrocardiogram screening of athletes. Journal of Science and Medicine in Sport, 2017. 20(2): p. 213-217. https://doi.org/10.1016/j.jsams.2016.06.010
[17] Wasfy MM, DeLuca J, Wang F, Berkstresser B, Ackerman KE, Eisman A, et al. ECG findings in competitive rowers: normative data and the prevalence of abnormalities using contemporary screening recommendations. British Journal of Sports Medicine, 2015. 49(3): p. 200-206. https://doi.org/10.1136/bjsports-2014-093919
[18] Orchard JJ, Orchard JW, La Gerche A, Kountouris A, Raju H, Young M, et al. Audit of a cardiac screening policy for elite Australian cricketers. Journal of Science and Medicine In Sport, 2020. 23(6): p. 541-547. https://doi.org/10.1016/j.jsams.2019.12.025
[19] Rajan D, Garcia R, Svane J, Tfelt-Hansen J. Risk of sports-related sudden cardiac death in women. European Heart Journal, 2022. 43(12): p. 1198-1206. https://doi.org/10.1093/eurheartj/ehab833
[20] Claessen C, Claessens P, Claessens M, Claessens J. Echocardiographic and physiological performance characteristics of triathletes. The Canadian Journal of Cardiology, 2000. 16(8).
[21] Claessens C, Claessens P, Bloemen H, Claessens M, Verbanck M, Fagard R, et al. Structural heart adaptations in triathletes. Acta Cardiologica, 1999. 54(6): p. 317-325.
[22] Shave R, Dawson E, Whyte G, George K, Gaze D, Collinson P. Altered cardiac function and minimal cardiac damage during prolonged exercise. Medicine and Science in Sports and Exercise, 2004. 36(7): p. 1098-1103. https://doi.org/10.1249/01.mss.0000131958.18154.1e
[23] Lo Iudice, F., et al., Determinants of myocardial mechanics in top-level endurance athletes: three-dimensional speckle tracking evaluation. European Heart Journal. Cardiovascular Imaging, 2017. 18(5): p. 549-555.
[24] Claessens P, Claessens C, Claessens M, Henderieckx J, Claessens J. Physiological or pseudophysiological ECG changes in endurance-trained athletes. Heart and Vessels, 2000. 15(4): p. 181-190. https://doi.org/10.1007/s003800070021
[25] Harris KM, Creswell LL, Haas TS, Thomas T, Tung M, Isaacson E, et al. Death and Cardiac Arrest in U.S. Triathlon Participants, 1985 to 2016: A Case Series. Annals of Internal Medicine, 2017. 167(8): p. 529-535. https://doi.org/10.7326/M17-0847
[26] Constantini NW, Dubnov-Raz G, Mountjoy M. Causes of sudden death during the triathlon. JAMA, 2010. 304(3): p. 269; author reply 269-269; author reply 270. https://doi.org/10.1001/jama.2010.982