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Many elite basketball players of the National Basketball Association (NBA) have abnormal ECG readings even when the latest athlete-specific screening criteria are applied, according to investigators.

By 2012's Seattle criteria, 25.2% had such abnormalities, compared with 20.8% under 2014's refined criteria and , reported David Engel, MD, of New York-Presbyterian/Columbia University Irving Medical Center, and colleagues online in JAMA Cardiology. Their study was the result of a partnership between the NBA and Columbia.

"Despite the improved specificity of the international recommendations over previous athlete-specific ECG criteria, abnormal ECG classification rates remain high in NBA athletes," the authors commented.

More likely to have an abnormal ECG were:

• Older athletes (9.1% for age 18-22 versus 22.6% for age 27-39, OR 2.9, 95% CI 1.6-5.4)
• Those with greater relative wall thickness (25.2% in highest versus 9.3% in lowest tertile, OR 3.3, 95% CI 1.8-6.1)

The most common ECG abnormality turned out to be T-wave inversions in the inferior and/or lateral leads, present in 6.2% of those screened. Associated with this were a smaller left ventricular cavity size (left ventricular end diastolic diameter 11.0% lowest tertile versus 1.4% highest, OR 8.6, 95% CI 2.0-37.9) and increased relative wall thickness (0.6% lowest tertile versus 14.7% highest, OR 29.5, 95% CI 3.9-221.0).

"This data may help us continue to enhance player health and safety by distinguishing expected changes in a basketball player's heart from underlying cardiac conditions," Engel said in a . "The current ECG criteria cannot encapsulate how the wide variation in physiologic demands of different sports, and the varied baseline characteristics of athletes engaged in different sports, create varied changes in athletes' ECGs. We still have more work to do to determine if more specific criteria for evaluating ECG data in different sports is needed."

Included in the study were 519 male NBA players, among whom 78.8% were African American and the remainder white.

"The NBA players in this study were generally older (mean age, 24.8 years; range, 18-39 years) than most athletes included in other published studies of athlete groups, and this fact, combined with the finding of more ECG abnormalities in the oldest group of NBA athletes in the present study, might demonstrate that athlete age and cumulative years of intense training are important factors that influence athletic ECG changes," the researchers suggested.

They acknowledged the lack of serial follow-up data collected for this study and the limited generalizability of their findings to youth basketball players and athletes in other sports.

In addition, there was no data on the use of anabolic steroids or other performance-enhancing agents among study participants, according to an by Sanjay Sharma, MD, of St. George's, University of London.

Still, Sharma said the study by Engel's group was important.

"It emphasizes the need for more detailed investigation in larger cohorts of black athletes to ascertain whether assessing the pattern, depth, and/or width of inferior/lateral T-wave inversion might help predict more precisely which black athletes might be at risk of cardiac disease or death," he said. "The association of concentric left ventricular remodeling or hypertrophy with inferior and/or lateral T-wave inversion raises the question of whether left ventricular hypertrophy induced by sports in black athletes might be a harbinger for serious arrhythmias, as is the case in black patients with hypertensive heart disease."

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