Clinical, Electrocardiographic, Echocardiographic Characteristics and Long Term Follow up of Elite Soccer Players with J Point Elevation

Background—J-point elevation is common in athletes; nevertheless, the influence of structural changes associated with the athlete’s heart and its prognostic impact are still debated. Our aim was to investigate the prevalence of J-point elevation, the associated clinical, electrocardiographic, and echocardiographic characteristics and its impact on long-term outcome in elite soccer players. Methods and Results—Clinical, electrocardiographic, and cardiopulmonary exercise test data from 332 male professional soccer players were retrospectively analyzed. For 235 (70.7%) athletes echocardiographic data were also available. J-point elevation was defined as an elevation ≥1 mm in ≥2 contiguous leads. Long-term follow-up data were obtained for all athletes, whereas univariate and multivariable analyses were performed to assess the associated characteristics. Overall, 118 (35.6%) athletes showed a J-point elevation ≥1 mm. At multivariable analysis a significant direct association of interventricular septum thickness (odds ratio for 1 SD increase, 1.361; 95% confidence interval, 1.019–1.817; P=0.036) and Sokolow–Lyon index (odds ratio for 1 SD increase, 1.367; 95% confidence interval, 1.026–1.822; P=0.033) and an inverse association of baseline heart rate (odds ratio for 1 SD increase, 0.686; 95% confidence interval, 0.508–0.927; P=0.011) with J-point elevation were observed. During a long-term follow-up (median, 13.3 years; first and third quartiles, 10.1–17.0 years), a low mortality rate was observed, not related to cardiovascular causes. Conclusions—The correlation between J-point elevation and interventricular septum thickness suggests a possible mechanistic role of exercise-induced left ventricular hypertrophy as the basis for J-point elevation. After a long-term follow-up, no cardiac death was observed.