Most of our knowledge of the athlete’s EKG is based on white athletes.
African/Afro-Caribbean athletes are more likely to have an abnormal EKG than white athletes in multiple studies.
Different selective criteria have been developed to minimize classification of benign normal patterns as abnormal.
The 2010 ESC criteria classified 40.4% of black athletes as abnormal versus the Refined criteria which resulted in 11.5% of EKGs classified as abnormal.
This reduction was aided by the recognition that isolated anterior TWI in asymptomatic black athletes is considered a benign finding.
Note this does NOT apply if the TWI extend to the lateral leads
For example, T-wave inversion (TWI) was present in 23% of African/Afro-Caribbean athletes vs. 3.7% of white athletes (usually in contiguous anterior leads).
Other changes included a higher prevalence of early repolarization, RV hypertrophy, and LA/RA enlargement.
References
1) Jacob et al., 2016. Ethnic and Gender Specific Differences Among Athletes Participating in ECG Screening.
2 )WIlson et al., 2012. Significance of deep T-wave inversions in asymptomatic athletes with normal cardiovascular examinations: practical solutions for managing the diagnostic conundrum.
3) Brown et al., 2017. THe Complex Phentype of the Athlete's Heart: Implications for the Preparticipation Screening.
