A novel 5-minute ECG screening approach to enhance CVD detection in master endurance athletes: insights from the 'Heart and Run' project

Abstract Introduction A growing number of athletes over the age of 40 engage in high-intensity endurance sports, which involve substantial cardiovascular strain. Cardiovascular disease (CVD) is a major cause of mortality in this population and increase with age. Given this risk, the effectiveness of the conventional annual Italian screening method for these athletes may be limited. Aim This study aims to evaluate whether a 5-minute ‘Event Recorder ECG,’ when used alongside conventional examination methods, serves as an effective additional screening tool for early CVD detection and prevention in master endurance athletes. Methods This cohort was selected from the larger "Heart and Run" project, a collection of ECGs from endurance athletes participating in Rome’s most renowned running international event. A control group of healthy age-matched individuals was also included for comparison. Resting ECGs were obtained using a mobile event recorder, and HRV indices were analyzed post hoc using Kubios software. Morphological features and HRV parameters were compared between groups. Results Over a three-year period (from 2021 to the present), we enrolled 660 individuals (360 athletes and 300 controls), with an average age of 56. Athletes exhibited higher rates of left anterior fascicular block (LAFB), first-degree AV block, J-point elevation, ST-segment abnormalities, PVCs, and shorter QTc intervals compared to controls (p<0.05). Differences in HRV analysis between the groups, both in time and frequency domains, confirmed increased vagal tone in master athletes (p<0.05). Using the reference range from the "Heart and Run" population (5th–95th percentile), we identified 7% of athletes with abnormal HRV and/or morphological ECG findings. These individuals were scheduled for further evaluation, including echocardiograms or 24-hour Holter ECG. Conclusions Master endurance athletes exhibit an increased vagal tone, which may offer protection against CVD. The addition of a 5-minute ECG to routine screening could enhance sensitivity in detecting potential CVD in this population, thereby contributing to the prevention of sudden cardiac death. This approach allows for more precise identification of athletes at risk for underlying cardiovascular conditions, who may benefit from additional investigations.