William Wiradinata, Muhammad Reva Aditya, Anita Dominique Subali, Hotma Lestari, Rivaldo Brahmantio Hardani, Nabilah Hanifah Mukti
Differentiating athlete’s heart from hypertrophic cardiomyopathy (HCM) in pediatric populations is challenging due to overlapping electrocardiographic (ECG) features. This systematic review and meta-analysis evaluated ECG parameters to identify features distinguishing pediatric HCM from physiological adaptations in young athletes. Literature searches in PubMed, ScienceDirect, and Google Scholar yielded 25 eligible studies. Data were synthesized using a random-effects meta-analysis to account for clinical and methodological heterogeneity across studies. Odds ratios with 95% confidence intervals were generated using the Mantel–Haenszel method for two-arm studies and were pooled using Review Manager 5.4, while single-arm proportions of ECG abnormalities in pediatric HCM patients were pooled using a random-effects single-arm meta-analysis in OpenMeta[Analyst]. Heterogeneity was quantified using the I2 statistic, and sensitivity analyses were conducted by excluding studies with a high risk of bias. Significant differences were found in QTc prolongation, T-wave and ST segment abnormalities, and pathological Q waves, which were more prevalent in HCM. Supplementing with one-arm studies and comparing to normative athlete data highlighted additional differences in axis deviation, atrial enlargement, and bundle branch blocks. Conclusion: Based on current data available, ECG can help in distinguishing athlete’s heart and HCM in the pediatric and adolescent population, particularly regarding QTc prolongation, T wave abnormalities, ST segment abnormalities, and pathological Q waves. ECG abnormalities detected during ECG should prompt further diagnostic evaluation for confirmation. (Table presented.) © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025.
Faculty of Medicine, Universitas Brawijaya, East Java, Malang, Indonesia; Dr. R. Hardjanto Level II Military Hospital, East Kalimantan, Balikpapan, Indonesia; Department of Cardiology and Vascular Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
