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Medicina dello Sport 2010 September;63(3):375-90


language: English, Italian

Atypical changes to ST-T segment after step-test during competitive sport fitness examination

Lombardi M. 1, 2, Faiola F. 1, 2, Luciani U. 1, 2, Claudio F. 1, 3, Bianchi G. 1, 2, Veicstenas A. 2, 4, Casasco M. 2, 3

1 Panathleticon, Sports Medicine, FMSI Operative Unit, Brescia, Italy 2 Italian Federation of Sports Medicine, FMSI, Rome, Italy 3 School of Sports Medicine, University of Brescia, Brescia, Italy 4 Department of Health Science, Nutrition and Sports, University of Milan, Milan, Italy


Aim. The incidence and possible causes of “aspecific” changes to the ST-T segment have been investigated. Presenting at ECG following a step test on the occasion of a competitive sports fitness examination, these changes were of uncertain diagnostic interpretation.
Methods. Basal and post-step-test electrocardiograms (ECGs) were examined in 6635 non-professional athletes (<35 years). The 53 athletes (0.8%) who presented “aspecific” repolarisation changes were submitted to the maximal ergometric test (MET) and resting (basal-Echocg) and exercise (stress-Echocg) echocardiography.
Results. In one case only the MET and stress-Echocg proved positive for stress-induced myocardial ischemia. Exercise scintigraphy confirmed the result and a coronary computed tomography (CT) scan excluded congenital anomalies. In the remaining 52 subjects, the MET was normal while basal-Echocg showed: ventricular tendinous cords (12 subjects); mitral valve prolapse with minimum, clinically irrelevant regurgitation (7 subjects); initial hypertrophy of the left ventricle interpretable as “athlete’s heart” (3 subjects); hypertrophy of the papillary muscles (4 subjects). The anomalies investigated are infrequent in young athletes, as it is demonstrated by most second level examinations which proved negative. In only one case did the MET and stress Echocg point to modifications indicative of ischaemic cardiopathy. Although this percentage is very low, it is recommended that second level examinations be carried out annually in these subjects as they do uncover anomalies when present. The group of subjects in whom basal-Echocg showed hypertrophy of the papillary muscles is interesting in that it is hypothesized that it could represent a possible initial stage of hypertrophic myocardiopathy.
Conclusion. Second level cardiological examinations should be carried out whenever “aspecific” anomalies of repolarisation are encountered in ECGs following step-tests in athletes who are otherwise considered healthy. These further investigations are generally sufficient to clarify any diagnostic problems created by aspecific changes in the ECG following step tests.

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