arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2015-21-1-32-39arthyper-171Research ArticleОРИГИНАЛЬНАЯ СТАТЬЯORIGINAL ARTICLEРАННИЕ ИЗМЕНЕНИЯ ЭЛЕКТРОКАРДИОГРАММЫ У ПРОФЕССИОНАЛЬНЫХ ФУТБОЛИСТОВ ПРЕДПОДРОСТКОВОГО ВОЗРАСТАEARLY ELECTROCARDIOGRAM CHANGES IN HIGHLY TRAINED PREADOLESCENT FOOTBALL PLAYERSЗдравковичМ.ZdravkovicM.

Здравкович Мария — профессор кардиологии, доцент, Медицинский центр Университетской клиники Бежанийска Коса, медицинский факультет, Университет Белграда, Белград, Сербия

Marija Zdravkovic, MD, PhD, Associate Professor Dr, Full Professor in Cardiology, University Hospital Medical Center Bezanijska Kosa, Faculty of Medicine, University of Belgrad, Belgrad, Serbia

sekcija.kardioloska@gmail.comМиловановичБ.MilovanovicB.

Милованович Бранислав — доцент, Медицинский центр Университетской клиники Бежанийска Коса, медицинский факультет, Университет Белграда, Белград, Сербия

Branislav Milovanovic, MD, PhD, Associate Professor in Cardiology, University Hospital Medical Center Bezanijska Kosa, Faculty of Medicine, University of Belgrad, Belgrad

sekcija.kardioloska@gmail.comНеделковичИ.NedeljkovicI.

Неделкович Ивана — доктор медицины, врач, Медицинский центр Сербии, кардиологическая клиника, медицинский факультет, Университет Белграда, Белград, Сербия

Ivana Nedeljkovic, MD, PhD, Clinical Center of Serbia, Clinic of Cardiology, Faculty of Medicine, University of Belgrad, Belgrad, Serbia; Mirjana Krotin, MD, PhD, Full Professor in Cardiology, University

КротинМ.KrotinM.

Кротин Мирьяна — профессор кардиологии, Медицинский центр Университетской клиники Бежанийска Коса, медицинский факультет, Университет Белграда, Белград, Сербия

Mirjana Krotin, MD, PhD, Full Professor in Cardiology, University Hospital Medical Center Bezanijska Kosa, Faculty of Medicine, University of Belgrad, Belgrad, Serbia

sekcija.kardioloska@gmail.comСолдатовичИ.SoldatovicI.

Солдатович Иван — доцент, Институт медицинской статистики, медицинский факультет, Университет Белграда, Белград, Сербия �, Сербия

sekcija.kardioloska@gmail.comАцимовичТ.AcimovicT.

Ацимович Тийяна — врач, Институт Физиологии, медицинский факультет, Университет Белграда, Белград, Сербия

Tijana Acimovic, MD, Clinical Doctor, Institute for Physiology, Faculty of Medicine, University of Belgrad, Belgrad

sekcija.kardioloska@gmail.comКорацевичА.KoracevicG.

Корацевич Горан — профессор, Кардиологическая клиника, медицинский факультет, Нишский университет, Ниш, Сербия ody> �, Сербия

sekcija.kardioloska@gmail.comЗдравковичД.ZdravkovicD.

Здравкович Дарко — доцент, Медицинский центр Университетской клиники Бежанийска Коса, медицинский факультет, Университет Белграда, Белград, Сербия

sekcija.kardioloska@gmail.comПриичС.PrijicS.

Приич Сергей — педиатр, доцент, Институт здоровья матери и ребенка «Vukan Cupic», отделение кардиологии, медицинский факультет, Университет Белграда, Белград, Сербия

Sergej Prijic, MD, PhD, Assistant Professor in Pediatrics, University Hospital Medical Center Bezanijska Kosa, Faculty of Medicine, University of Belgrad, Belgrad, Serbia

sekcija.kardioloska@gmail.comВукомановичВ.VukomanovicV.

Вукоманович Владимир — профессор кардиологии, Институт здоровья матери и ребенка «Vukan Cupic», отделение кардиологии, медицинский факультет, Университет Белграда, Белград, Сербия

sekcija.kardioloska@gmail.comДимковичС.DimkovicS.

Димкович Синиса — профессор кардиологии, Медицинский центр Университетской клиники Бежанийска Коса, медицинский факультет, Университет Белграда, Белград, Сербия

sekcija.kardioloska@gmail.comМарковичО.MarkovicO.

Маркович Оливера — доцент, Медицинский центр Университетской клиники Бежанийска Коса, медицинский факультет, Университет Белграда, Белград, Сербия

sekcija.kardioloska@gmail.comФилиповичБ.FilipovicB.

Филипович Бранка — доцент, Медицинский центр Университетской клиники Бежанийска Коса, медицинский факультет, Университет Белграда, Белград, Сербия

Branka Filipovic, MD, PhD, Assistant Professor in Internal Medicine, University Hospital Medical Center Bezanijska Kosa, Faculty of Medicine, University of Belgrad, Belgrad, Serbia;

sekcija.kardioloska@gmail.comСтевановичП.StevanovicP.

Стеванович Предраг — профессор анестезиологии, Медицинский центр Университетской клиники Бежанийска Коса, медицинский факультет, Университет Белграда, Белград, Сербия

sekcija.kardioloska@gmail.comМазичС.MazicS.

Мазич Санья — профессор физиологии, Институт Физиологии, медицинский факультет, Университет Белграда, Белград, Сербия �рбия

sekcija.kardioloska@gmail.comМедицинский центр Университетской клиники Бежанийска Коса, медицинский факультет, Университет Белграда, БелградЧехословакияUniversity Hospital Medical Center Bezanijska Kosa, Faculty of Medicine, University of Belgrad, BelgradCzechoslovakiaМедицинский центр Сербии, кардиологическая клиника, медицинский факультет, Университет БелградаЧехословакияInstitute for Physiology, Faculty of Medicine, University of Belgrad, BelgradCzechoslovakiaИнститут медицинской статистики, медицинский факультет, Университет Белграда, БелградЧехословакияInstitute for Medical Statistics, Faculty of Medicine, University of Belgrad, BelgradCzechoslovakiaИнститут Физиологии, медицинский факультет, Университет Белграда, БелградЧехословакияInstitute for Physiology, Faculty of Medicine, University of Belgrad, BelgradCzechoslovakiaКардиологическая клиника, медицинский факультет, Нишский университет, НишРоссияClinic for Cardiology, Faculty of Medicine, University of Nis, NisRussian FederationИнститут здоровья матери и ребенка «Vukan Cupic», отделение кардиологии, медицинский факультет, Университет БелградаЧехословакияInstitute for Child and Mother Care «Vukan Cupic», Dept. of Cardiology, Faculty of Medicine, University of BelgradCzechoslovakiaInstitute for Child and Mother Care «Vukan Cupic», Dept. of Cardiology, Faculty of Medicine, University of BelgradCzechoslovakiaInstitute for Physiology, Faculty of Medicine, University of Belgrad, BelgradCzechoslovakia2015290420152113239Copyright © Здравкович М., Милованович Б., Неделкович И., Кротин М., Солдатович И., Ацимович Т., Корацевич А., Здравкович Д., Приич С., Вукоманович В., Димкович С., Маркович О., Филипович Б., Стеванович П., Мазич С., 20152015Здравкович М., Милованович Б., Неделкович И., Кротин М., Солдатович И., Ацимович Т., Корацевич А., Здравкович Д., Приич С., Вукоманович В., Димкович С., Маркович О., Филипович Б., Стеванович П., Мазич С.Zdravkovic M., Milovanovic B., Nedeljkovic I., Krotin M., Soldatovic I., Acimovic T., Koracevic G., Zdravkovic D., Prijic S., Vukomanovic V., Dimkovic S., Markovic O., Filipovic B., Stevanovic P., Mazic S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/171

Цель исследования — оценить ранние изменения электрокардиограммы (ЭКГ), возникшие на фоне физических нагрузок, у профессиональных футболистов предподросткового возраста.

Материалы и методы

Материалы и методы. В исследование было включено 94 мальчика (средний возраст — 12,85 ± 0,84 года), профессионально занимающихся футболом в составе Сербской футбольной Лиги (не менее 7 часов тренировок в неделю), и 47 не занимающихся профессиональным спортом здоровых мальчиков того же возраста. Всем в качестве скринингового обследования были проведены регистрация ЭКГ и эхокардиографическое исследование в кардиологических центрах третьей ступени. Здоровые дети из контрольной группы вели малоподвижный образ жизни (менее 2 часов тренировок в неделю). Проведено сравнение общепринятых ЭКГ-показателей — интервалов и вольтажных характеристик, и определены референсные значения у профессиональных футболистов предподросткового возраста.

Результаты

Результаты. Между детьми, профессионально занимающимися футболом и ведущими малоподвижный образ жизни, выявлены существенные различия по всем оцениваемым показателям ЭКГ: по амплитуде зубца Р (p < 0,001), амплитуде зубца S (в отведении V1 или V2) (p < 0,001), амплитуде зубца R (в отведении V5 и V6) (p < 0,001), алгебраической сумме зубцов S1,2 + V5,6 (p < 0,001), амплитуде зубца T (p < 0,001), длительности комплекса QRS (p < 0,001), длительности зубца T (p < 0,001), длительности интервала QTc (p < 0,001) и отношению зубцов R/T (p <0,001). Различий в длительности интервала PQ между группами выявлено не было (p > 0,05). Длительность интервала QTc у спортсменов положительно коррелировала с размером левого предсердия, с конечносистолическим и конечно-диастолическим размерами левого желудочка (ЛЖ), индексом массы миокарда  (ММ) ЛЖ, индексами ММЛЖ/ППТ (площадь поверхности тела) 1,5 и ММЛЖ/рост 2,7, хотя связь не была очень сильной. Длительность интервала QTc не коррелировала с ММЛЖ и толщиной стенки ЛЖ.

Выводы

Выводы. Изменения показателей ЭКГ отмечаются у спортсменов на очень ранних стадиях ремоделирования. Удлинение QTc может рассматриваться как ранний предиктор физиологического ремоделирования ЛЖ у профессиональных футболистов предподросткового возраста.

Objective

Objective. To assess the early electrocardiogram (ECG) changes induced by physical training in preadolescent professional football players.

Design and methods

Design and methods. Ninety-four highly trained male football players (mean age —12,85 ± 0,84 years) competing in the Serbian Football League (at least 7 training hours/week) and 47 age-matched healthy male controls were enrolled in the study. They were screened by ECG and echocardiography at a tertiary referral cardiocentre. The control group had sedentary life style (less than 2 training hours/week). Characteristic ECG intervals and ECG voltage were compared and reference range was given for preadolescent footballers.

Results

Results. Highly significant differences between preadolescent athletes and sedentary controls were registered in all ECG parameters: P wave voltage (p < 0,001), S wave (V1 or V2 lead) voltage (p < 0,001), R wave (V5 and V6 lead) voltage (p < 0,001), ECD sum of the S1,2 + V5,6 (p < 0,001), T wave voltage (p < 0,001), QRS complex duration (p < 0,001), T wave duration (p < 0,001), QTc interval duration (p < 0,001) and R/T ratio (p < 0,001). No differences were registered in PQ interval duration between these two groups (p > 0,05). QTc interval duration in athletes was not very strongly, but indeed positively correlated with left atrium dilatation, left ventricular (LV) end-systolic and end-diastolic dimensions, LV myocardial index (LVMI), LVM/body surface area (BSA)1,5 and LVM/h2,7 indices. There was no correlation between QTc interval duration and LVM as well asLV wall thickness.

Conclusions

Conclusions.ECG changes are present in the early stage of athletes’ heart remodeling. QTc prolongation could be the early ECG marker of physiologicalLV remodeling in young preadolescent footballers.

спортсменыкардиологияэлектрокардиографиясердцефутболистыдетский возрастathletescardiologyelectrocardiographyheartfootballerspreadolescenceDr. Marija Zdravkovic, Ministry of Science of Republic of SerbiaReferencesBaggish AL, Wood MJ. Athlete’s heart and cardiovascular care of the athlete: scientific and clinical update. Circulation. 2011;123(23):2723–2735.Baggish AL, Wood MJ. Athlete’s heart and cardiovascular care of the athlete: scientific and clinical update. Circulation. 2011;123(23):2723–2735.Asif IM, Drezner JA. Detecting occult cardiac disease in athletes: history that makes a difference. Br J Sports Med. 2013;47 (11):669.Asif IM, Drezner JA. Detecting occult cardiac disease in athletes: history that makes a difference. Br J Sports Med. 2013;47 (11):669.Williams ES, Owens DS, Drezner JA, Prutkin JM. Electr ocardiogram interpretation in the athlete. Herzschrittmacher ther Elektrophysiol. 2012;23 (2):65–71.Williams ES, Owens DS, Drezner JA, Prutkin JM. Electr ocardiogram interpretation in the athlete. Herzschrittmacher ther Elektrophysiol. 2012;23 (2):65–71.Corrado D, Pelliccia A, Heidbuchel H et al. Section of sports cardiology, European Association of Cardiovascular Prevention and Rehabilitation. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Section of Sports Cardiology, European Association of Cardiovascular Prevention and Rehabilitation. Eur Heart J. 2010;31(2):243–259.Corrado D, Pelliccia A, Heidbuchel H et al. Section of sports cardiology, European Association of Cardiovascular Prevention and Rehabilitation. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Section of Sports Cardiology, European Association of Cardiovascular Prevention and Rehabilitation. Eur Heart J. 2010;31(2):243–259.Lang RM, Bierig M, Devereux RB et al. Chamber Quantification Writing Group; American Society of Echocar-diography’s Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18 (12):1440–1463.Lang RM, Bierig M, Devereux RB et al. Chamber Quantification Writing Group; American Society of Echocar-diography’s Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18 (12):1440–1463.Langdeau JB, Blier L, Turcotte H et al. Electrocardiographic findings in athletes: the prevalence of left ventricular hypertrophy and conduction defects. Can J Cardiol. 2001;17(6):655–659.Langdeau JB, Blier L, Turcotte H et al. Electrocardiographic findings in athletes: the prevalence of left ventricular hypertrophy and conduction defects. Can J Cardiol. 2001;17(6):655–659.Макаров Л. М. Внезапная смерть у спортсменов молодого возраста. Кардиология. 2010;50(2):78–83. [Makarov LM. Sudden death in young athletes. Cardiology = Kardiologiia. 2010;50(2):78–83. In Russian].Макаров Л. М. Внезапная смерть у спортсменов молодого возраста. Кардиология. 2010;50(2):78–83. [Makarov LM. Sudden death in young athletes. Cardiology = Kardiologiia. 2010;50(2):78–83. In Russian].Drezner JA, Ackerman MJ, Cannon BC et al. Abnormal electrocardiographic findings in athletes: recognising changes suggestive of primary electrical disease. Br J Sports Med. 2013;47 (3):153–167.Drezner JA, Ackerman MJ, Cannon BC et al. Abnormal electrocardiographic findings in athletes: recognising changes suggestive of primary electrical disease. Br J Sports Med. 2013;47 (3):153–167.Walker J, Calkins H, Nazarian S. Evaluation of cardiac arrhythmia among athletes. Am J Med. 2010;123(12):1075–1081.Walker J, Calkins H, Nazarian S. Evaluation of cardiac arrhythmia among athletes. Am J Med. 2010;123(12):1075–1081.Zdravkovic M, Perunicic J, Krotin M et al. Echocardiographic study of early left ventricular remodeling in highly trained preadolescent footballers. J Sci Med Sport. 2010;13(6):602–606.Zdravkovic M, Perunicic J, Krotin M et al. Echocardiographic study of early left ventricular remodeling in highly trained preadolescent footballers. J Sci Med Sport. 2010;13(6):602–606.Drezner JA, Fischbach P, Froelicher V et al. Normal electrocardiographic findings: recognising physiological adaptations in athletes. Br J Sports Med. 2013;47(3):125–136.Drezner JA, Fischbach P, Froelicher V et al. Normal electrocardiographic findings: recognising physiological adaptations in athletes. Br J Sports Med. 2013;47(3):125–136.Pelliccia A, Maron BJ, Spataro A et al. The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med. 1991;324(5):295–301.Pelliccia A, Maron BJ, Spataro A et al. The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med. 1991;324(5):295–301.Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man. Circulation. 1977;55(4):613–618.Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man. Circulation. 1977;55(4):613–618.De Simone G, Daniels SR, Devereux RB. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol. 1992;20(5):1251–1260.De Simone G, Daniels SR, Devereux RB. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol. 1992;20(5):1251–1260.Rautaharju PM, Surawicz B, Gettes LS et al. American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; American College of Cardiology Foundation; Heart Rhythm Society American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; American College of Cardiology Foundation; Heart Rhythm Society. AHA/ACCF/HRS.recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol. 2009;53(11):982–991.Rautaharju PM, Surawicz B, Gettes LS et al. American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; American College of Cardiology Foundation; Heart Rhythm Society American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; American College of Cardiology Foundation; Heart Rhythm Society. AHA/ACCF/HRS.recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol. 2009;53(11):982–991.Napolitano C, Bloise R, Priori SG. Long QT syndrome and short QT syndrome: how to make correct diagnosis and what about eligibility for sports activity. J Cardiovasc Med (Hagerstown). 2006;7(4):250–256.Napolitano C, Bloise R, Priori SG. Long QT syndrome and short QT syndrome: how to make correct diagnosis and what about eligibility for sports activity. J Cardiovasc Med (Hagerstown). 2006;7(4):250–256.Maron BJ, Chaitman BR, Ackerman MJ et al. Working Groups of the American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention; Councils on Clinical Cardiology and Cardiovascular Disease in the Young. Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases. Circulation. 2004;109(22):2807–2816.Maron BJ, Chaitman BR, Ackerman MJ et al. Working Groups of the American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention; Councils on Clinical Cardiology and Cardiovascular Disease in the Young. Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases. Circulation. 2004;109(22):2807–2816.Tanguturi VK, Noseworthy PA, Newton-Cheh C et al. The electrocardiographic early repolarization pattern in athletes: normal variant or sudden death risk factor? Sports Med. 2012;42 (5):359–366.Tanguturi VK, Noseworthy PA, Newton-Cheh C et al. The electrocardiographic early repolarization pattern in athletes: normal variant or sudden death risk factor? Sports Med. 2012;42 (5):359–366.Corrado D, Biffi A, Basso C et al. 12-lead ECG in the athlete: physiological versus pathological abnormalities. Br J Sports Med. 2009;43(9):669–676.Corrado D, Biffi A, Basso C et al. 12-lead ECG in the athlete: physiological versus pathological abnormalities. Br J Sports Med. 2009;43(9):669–676.Toufan M, Kazemi B, Akbarzadeh F, Ataei A, Khalili M. Assessment of electrocardiography, echocardiography, and heart rate variability in dynamic and static type athletes. Int J Gen Med. 2012;5:655–660.Toufan M, Kazemi B, Akbarzadeh F, Ataei A, Khalili M. Assessment of electrocardiography, echocardiography, and heart rate variability in dynamic and static type athletes. Int J Gen Med. 2012;5:655–660.Basavarajaiah S, Wilson M, Whyte G et al. Prevalence of hypertrophic cardiomyopathy in highly trained athletes: relevance to pre-participation screening. J Am Coll Cardiol. 2008;51 (10):1033–1039.Basavarajaiah S, Wilson M, Whyte G et al. Prevalence of hypertrophic cardiomyopathy in highly trained athletes: relevance to pre-participation screening. J Am Coll Cardiol. 2008;51 (10):1033–1039.La Gerche A, Macisaac AI, Prior DL. Should preparticipation cardiovascular screening for competitive athletes be introduced in Australia? A timely debate in a sport-loving nation. Heart Lung Circ. 2011;20(10):629–633.La Gerche A, Macisaac AI, Prior DL. Should preparticipation cardiovascular screening for competitive athletes be introduced in Australia? A timely debate in a sport-loving nation. Heart Lung Circ. 2011;20(10):629–633.Patel DR, Luckstead EF. Update on cardiovascular screening: can we prevent sudden cardiac death in adolescent athletes? Adolesc Med State Art Rev. 2013;24(1):225–241.Patel DR, Luckstead EF. Update on cardiovascular screening: can we prevent sudden cardiac death in adolescent athletes? Adolesc Med State Art Rev. 2013;24(1):225–241.Zaidi A, Ghani S, Sharma R et al. Physiological right ventricular adaptation in elite athletes of African and AfroCaribbean origin. Circulation. 2013;127(17):1783–1792.Zaidi A, Ghani S, Sharma R et al. Physiological right ventricular adaptation in elite athletes of African and AfroCaribbean origin. Circulation. 2013;127(17):1783–1792.Palatini P, Maraglino G, Mos L et al. Effect of endurance training on Q-T interval and cardiac electrical stability in boys aged 10 to 14. Ventricular arrhythmias in trained boys. Cardiology. 1987;74(5):400–407.Palatini P, Maraglino G, Mos L et al. Effect of endurance training on Q-T interval and cardiac electrical stability in boys aged 10 to 14. Ventricular arrhythmias in trained boys. Cardiology. 1987;74(5):400–407.Stolt A, Kujala UM, Karjalainen J, Vitasalo M. Electroc ardiographic findings in female endurance athletes. Clin J Sport Med. 1997;7(2):85–89.Stolt A, Kujala UM, Karjalainen J, Vitasalo M. Electroc ardiographic findings in female endurance athletes. Clin J Sport Med. 1997;7(2):85–89.Sharma S, Whyte G, Elliott P et al. Electrocardiographic changes in 1000 highly trained junior elite athletes. Br J Sports Med. 1999;33(5):319–314.Sharma S, Whyte G, Elliott P et al. Electrocardiographic changes in 1000 highly trained junior elite athletes. Br J Sports Med. 1999;33(5):319–314.Sheikh N, Papadakis M, Carre F et al. Cardiac adaptation to exercise in adolescent athletes of African ethnicity: an emergent elite athletic population. Br J Sports Med. 2013;47(9):585–592.Sheikh N, Papadakis M, Carre F et al. Cardiac adaptation to exercise in adolescent athletes of African ethnicity: an emergent elite athletic population. Br J Sports Med. 2013;47(9):585–592.Chandra N, Papadakis M, Sharma S. Cardiac adaptation in athletes of black ethnicity: differentiating pathology from physiology. Heart. 2012;98(16):1194–1200.Chandra N, Papadakis M, Sharma S. Cardiac adaptation in athletes of black ethnicity: differentiating pathology from physiology. Heart. 2012;98(16):1194–1200.

The authors declare that there are no conflicts of interest present.