Ethnicity is an important determinant of cardiovascular adaptation to exercise and should be considered during interpretation of the electrocardiogram and echocardiogram in athletes
Athletes of African or Afro-Caribbean ethnicity (black athletes) reveal profound electrical and structural alterations in response to exercise; 23% exhibit T-wave inversion and 13% left ventricular hypertrophy
Application of current electrocardiographic interpretation criteria derived from white athletes would result in >40% of black athletes being diagnosed with an abnormal electrocardiogram
In the absence of symptoms or family history of cardiomyopathy, T-wave inversion confined to leads V1–V4 is likely to represent an ethnically determined, physiological response to exercise in black athletes
Middle-Eastern athletes seem to exhibit similar electrical and structural changes in response to exercise as white athletes
More data are required for athletes from East and South Asia before conclusions can be made regarding cardiac adaptation to exercise in these ethnicities
The increasing globalization of sport has resulted in athletes from a wide range of ethnicities emerging onto the world stage. Fuelled by the untimely death of a number of young professional athletes, data generated from the parallel increase in preparticipation cardiovascular evaluation has indicated that ethnicity has a substantial influence on cardiac adaptation to exercise. From this perspective, the group most intensively studied comprises athletes of African or Afro-Caribbean ethnicity (black athletes), an ever-increasing number of whom are competing at the highest levels of sport and who often exhibit profound electrical and structural cardiac changes in response to exercise. Data on other ethnic cohorts are emerging, but remain incomplete. This Review describes our current knowledge on the impact of ethnicity on cardiac adaptation to exercise, starting with white athletes in whom the physiological electrical and structural changes—collectively termed the 'athlete's heart'—were first described. Discussion of the differences in the cardiac changes between ethnicities, with a focus on black athletes, and of the challenges that these variations can produce for the evaluating physician is also provided. The impact of ethnically mediated changes on preparticipation cardiovascular evaluation is highlighted, particularly with respect to false positive results, and potential genetic mechanisms underlying racial differences in cardiac adaptation to exercise are described.
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The authors declare no competing financial interests.
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Sheikh, N., Sharma, S. Impact of ethnicity on cardiac adaptation to exercise. Nat Rev Cardiol 11, 198–217 (2014). https://doi.org/10.1038/nrcardio.2014.15
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