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      Electrocardiographic manifestations in female team handball players: analyzing ECG changes in athletes

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          Abstract

          Introduction

          Long-term intense training leads to structural, functional, and electrical remodeling of the heart. How different sports affect the heart has not been fully investigated, particularly for female athletes. The aim of the present study was to investigate the morphology of 12-lead resting electrocardiogram (ECG) in elite female handball players compared to non-athlete female subjects. Potential changes will be explored to see if they could be explained by differences in cardiac dimensions and exercise hours.

          Materials and methods

          A cross-sectional study of 33 elite female team handball players compared to 33 sex and age-matched, non-athletic controls (age range 18–26 years) was performed. All participants underwent a resting 12-lead ECG and an echocardiographic examination. ECG variables for left ventricular hypertrophy and durations were evaluated and adjusted for cardiac dimensions and exercise hours using ANCOVA analysis. A linear regression analysis was used to describe relation between echocardiographic and ECG measures and exercise hours.

          Results

          The female handball players had larger cardiac dimensions and significantly lower heart rate and QTc duration (Bazett's formula) as well as increased QRS and QT durations compared to controls. The 12-lead sum of voltage and the 12-lead sum of voltage ∗ QRS were significantly higher among handball players. Changes in ECG variables reflecting the left ventricle could in part be explained by left ventricular size and exercise hours. Correlation with exercise hours were moderately strong in most of the echocardiographic measures reflecting left ventricular (LV), left ventricular mass (LVM), left atrium (LA) and right atrium (RA) size. Poor to fair correlations were seen in the majority of ECG measures.

          Conclusions

          Female team handball players had altered ECGs, longer QRS and QT durations, higher 12-lead sum of voltage and 12-lead sum of voltage ∗ QRS as well as shorter QTc (Bazett's formula) duration compared to non-athletic controls. These findings could only partly be explained by differences in left ventricular size. Despite larger atrial size in the athletes, no differences in P-wave amplitude and duration were found on ECG. This suggest that both structural, and to some degree electrical remodeling, occur in the female team handball players' heart and highlight that a normal ECG does not rule out structural adaptations. The present study adds knowledge to the field of sports cardiology regarding how the heart in female team handball players adapts to this type of sport.

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          Most cited references38

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          Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.

          The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines.
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            Biostatistics 104: correlational analysis.

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              Comparative left ventricular dimensions in trained athletes.

              Little is known about the structure of athletes' hearts of anatomic variations associated with training. Echocardiograms of 56 active athletes were obtained. Mean left ventricular end-diastolic volume and mass were increased in athletes involved in isotonic exercise, such as swimming (181 ml, 308 g) and running (160 ml, 302 g), compared with controls (101 ml, 211 g); wall thickness was normal (less than or equal to 12 mm). Athletes involved in isometric exercise, such as werstling and shot putting, had normal mean left ventricular end-diastolic volumes (110 ml, 122 ml), but increased wall thickness (13 to 14 mm) and mass (330 g, 348 g). Thus, athletes participating in isotonic exercise had increased left ventricular mass with cardiac changes similar to those in chronic volume overloads. Athletes participating in isometric exercise had increased left ventricular mass with cardiac changes similar to those in chronic pressure loads, recognizing greater left ventricular mass and volume in well-trained athletes aids in interpreting values deviating from "normal" limits.
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                Author and article information

                Contributors
                URI : https://loop.frontiersin.org/people/2653446/overviewRole: Role: Role: Role: Role: Role: Role: Role: Role: Role: Role: Role: Role: Role:
                Role: Role: Role: Role: Role:
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                Journal
                Front Sports Act Living
                Front Sports Act Living
                Front. Sports Act. Living
                Frontiers in Sports and Active Living
                Frontiers Media S.A.
                2624-9367
                26 April 2024
                2024
                : 6
                : 1384483
                Affiliations
                [ 1 ]Department of Translational Medicine, Lund University , Malmö, Sweden
                [ 2 ]Department of Medical Imaging and Physiology, Skåne University Hospital , Malmö, Sweden
                [ 3 ]Department of Biomedical Science, Faculty of Health and Society, Malmö University , Malmö, Sweden
                [ 4 ]Department of Clinical Sciences Lund, Lund University, Clinical Physiology and Skåne University Hospital , Lund, Sweden
                [ 5 ]Department of Cardiology, Skåne University Hospital , Malmö, Sweden
                Author notes

                Edited by: Moisés Silva, University of Porto, Portugal

                Reviewed by: Bruce Rogers, University of Central Florida, United States

                Emidio Marques De Matos Neto, Federal University of Piauí, Brazil

                [* ] Correspondence: A. Malmgren andreas.malmgren@ 123456skane.se
                Article
                10.3389/fspor.2024.1384483
                11084279
                38737439
                b6a5c10d-fb49-433d-ae28-cad0239c49fc
                © 2024 Malmgren, Trägårdh, Gudmundsson, Kjellström, Stagmo and Dencker.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 13 February 2024
                : 28 March 2024
                Page count
                Figures: 1, Tables: 5, Equations: 2, References: 38, Pages: 0, Words: 0
                Funding
                The author(s) declare that financial support was received for the research, authorship, and/or publication of this article.
                This study was supported by financial grants from Lundgrens foundation, Lund University, Skåne University Hospital and Region Skåne.
                Categories
                Sports and Active Living
                Original Research
                Custom metadata
                Exercise Physiology

                athlete,echocardiography,electrocardiography,left ventricle,left ventricular mass

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