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Title: Defining the electrical and structural adaptations of the adolescent athlete’s heart
Author: Malhotra, Aneil
ISNI:       0000 0004 7427 133X
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2018
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Background: Adolescent athletes (aged 14 to 18 years) comprise the largest cohort of exercising individuals in any Western nation, yet are the most vulnerable to exercise-related sudden cardiac death (SCD) from hereditary or congenital abnormalities affecting the muscle or electrical system of the heart. There are a paucity of data regarding the adolescent athlete’s heart with the vast majority of studies based on adult athletes. Not only are adolescent athletes significantly understudied compared with adults but in particular, the thesis evaluates differences between white, black and mixed race athletes, the latter group of which is the fastest growing ethnic group participating in sport in the UK and US and for whom no such previous data exist. Aims: This thesis aimed to help fill that void by defining the adolescent athlete’s heart both electrically and structurally and to facilitate the differentiation of physiological changes from inherited and congenital conditions in this age group. In particular, this thesis focused on: 1) the ECGs of adolescent athletes in the context of contemporary ECG recommendations, with particular emphasis on markers of cardiac pathology such as T wave inversion; 2) the echocardiogram features in adolescent athletes that can define normal left ventricular wall thickness and chamber size, differentiating these from hypertrophic cardiomyopathy and dilated cardiomyopathy respectively; 3) the prevalence of cardiac conditions among adolescent athletes and outcomes of the largest mandatory screening programme for elite adolescent athletes; 4) secondary prevention strategies and emergency response facilities for adolescent athletes who suffer SCD. Methodology: All athletes were recruited through pre-participation screening. ECG and echocardiogram data from 11,168 adolescent football players have been acquired and systematically analyzed from the largest screening programme for junior elite athletes in the world, run by the Football Association (FA), for the identification of young players at risk of SCD in England and Wales. Results: 1) Adolescent athletes undergo similar qualitative electrical and structural changes to adult athletes. 2) Black male adolescent athletes demonstrate the greatest quantitative changes compared with white and mixed race athletes. 3) The upper limits of physiological increases in left ventricular wall thickness and cavity size in adolescent athletes of both sexes are identified for the first time to aid differentiation between physiological adaptation and pathological cardiac enlargement. 4) Current ECG recommendations for interpretation of the adult athlete are applicable to adolescent athletes with the international criteria identifying the lowest number of false positive ECGs. 5) Anterior T wave inversion in V1-V2 is a normal variant in young, asymptomatic white athletes and non-athletes. The rarity of T wave inversion beyond V2 warrants further investigation in athletes and non-athletes. 6) The prevalence of serious cardiac conditions in screened adolescent athletes is 0.35% with the most common inherited condition being hypertrophic cardiomyopathy. The prevalence of minor pathology is 2%. 7) The incidence of sudden cardiac death in adolescent athletes screened by the Football Association is estimated at 1 in 14,794 per year with hypertrophic cardiomyopathy the commonest cause of SCD. 8) While current primary and secondary prevention strategies for sudden cardiac death and emergency response provisions within professional football in England and Wales outperform European counterparts, there are variations between the leagues with the highest standards confined to the upper echelons. Conclusions: The results gained from this thesis provide important data that will inform ECG and echocardiogram interpretation and screening policy in adolescent athletes in the UK and internationally.
Supervisor: Sharma, Sanjay Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available