Associazione Nazionale Medici Cardiologi Ospedalieri



ECG screening for cardiovascular disease in endurance athletes over 40

Liporace Paola Roma(Roma) – Policlinico Campus Bio-Medico | Ricciardi Danilo Roma(Roma) – Policlinico Campus Bio-Medico | Crispino Enrico Roma(Roma) – Policlinico Campus Bio-Medico


Cardiovascular diseases (CVD) increase with age. There are many athletes aged >40 years who practise endurance sports, that involve very high intensity physical exertion and prolonged efforts. This population undergo to annual examination with a medical history, spirometry, urine test and exercise test. CV and sudden cardiac death are the main cause of mortality in athletes during sport, so this kind of screening remains controversial. The aim of the study is to evaluate whether a 5-minute ‘Event Recorder ECG ‘, associated with the conventional examination, can have an additional role for early screening and prevention of CVD in older endurance sport population.

Materials and Methods

The population were selected as part of the larger ‘Heart And Run ‘ project, an ECG collection of endurance athletes in Rome-Italy. A control group of healty individiuals was collected for comparison. The ECG traces were recorded at rest for 5 minutes with the Kardia Mobile 6L device. The study group were compared for an ECG morphological analysis and for HRV parameters in the time and frequency domain.


A total of 353 subjects (182 athletes and 171 controls) were analysed. The athlets show a significantly higher incidence of sinus arrhythmias, LAFB, 1° degree AV Block, J-point elevation and ST-segment abnormalities. We found also a significantly shorter QTc in athlets compared to controls. In line with the ECG findings, the HRV PNS and SNS indices were respectively higher and lower in the athlete group than in the controls, confirming a higher vagal tone. Due to the absence of normality range, we considered values lower of the 5th or higher of the 95th percentile range, for the main HRV parameters, as abnormals. We identified 29/182 virtually abnormal HRV individuals. Those patients could be at increased CV risk, worthy of further investigation. In total, out-of-range HRV values or morphological abnormalities were detected in 54 athletes (29% of the total), a population that will need further attention through follow-up and additional examinations.


Despite competitive endurance sports are associated with increased vagal tone, which is virtually protective against CV diseases, even in athletes over 40, the addition of the 5-minute ‘Event Recorder ECG ‘ could increase the sensitivity in detection of CVD suggesting additional clinical and instrumental investigations in such patients.