{"doi":"10.1016/j.hrthm.2025.05.004","title":"Sex-specific performance of electrocardiographic criteria for left ventricular hypertrophy in elite athletes","abstract":null,"journal":"Heart Rhythm","year":2026,"id":615453,"datarank":0.24141568686511508,"base_score":1.6094379124341003,"endowment":1.6094379124341003,"self_citation_contribution":0.24141568686511508,"citation_network_contribution":0.0,"self_endowment_contribution":0.24141568686511508,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1586336,"name":"Joelle J.N. Daems","orcid":null,"position":1,"is_corresponding":false},{"id":1586337,"name":"Sjoerd M. Verwijs","orcid":null,"position":2,"is_corresponding":false},{"id":1586338,"name":"Juliette C. Van Hattum","orcid":null,"position":3,"is_corresponding":false},{"id":289148,"name":"S. Matthijs Boekholdt","orcid":"0000-0002-0861-0765","position":4,"is_corresponding":false},{"id":1586339,"name":"Adrienne Van Randen","orcid":null,"position":5,"is_corresponding":false},{"id":509681,"name":"R. Nils Planken","orcid":"0000-0003-3940-4670","position":6,"is_corresponding":false},{"id":1586340,"name":"Maarten H. Moen","orcid":null,"position":7,"is_corresponding":false},{"id":1586342,"name":"Stephan Van der Zwaard","orcid":null,"position":8,"is_corresponding":false},{"id":1586343,"name":"Nick Bijsterveld","orcid":null,"position":9,"is_corresponding":false},{"id":55699,"name":"Jan A. Kors","orcid":"0000-0002-4929-026X","position":10,"is_corresponding":false},{"id":789913,"name":"Pieter G. Postema","orcid":"0000-0003-2863-9159","position":11,"is_corresponding":false},{"id":230116,"name":"Arthur A.M. Wilde","orcid":"0000-0002-0528-0852","position":12,"is_corresponding":false},{"id":21948,"name":"Folkert W. Asselbergs","orcid":"0000-0002-1692-8669","position":13,"is_corresponding":false},{"id":1586344,"name":"Harald T. Jørstad","orcid":null,"position":14,"is_corresponding":false},{"id":1586335,"name":"Maarten A. Van Diepen","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Sex-specific performance of electrocardiographic criteria for left ventricular hypertrophy in elite athletes","abstract":"BACKGROUND: In athletes, left ventricular hypertrophy (LVH) criteria based on electrocardiograms (ECGs) have been validated almost exclusively in men using echocardiography. Sex-specific cardiac magnetic resonance (CMR) validation is lacking. OBJECTIVE: To evaluate ECG-LVH criteria against contrast-enhanced CMR in male and female elite athletes. METHODS: Cross-sectional study in healthy elite athletes. Eight ECG-LVH criteria of voltages and products and QRS duration were quantified using automated ECG analysis, and compared to CMR-derived LVH indicators (indexed left ventricular mass (LVM) and maximum left ventricular wall thickness (maxLVWT). Primary metrics of interest were sex-specific correlations (ρ) between ECG-LVH criteria and LVM/maxLVWT. Secondary metrics included discriminative performance (AUROC) and sensitivity at a 95%-specificity level for detecting increased LVM or maxLVWT. RESULTS: Among 209 elite athletes (median age 25, 45% women), men more frequently met one or more voltage criteria than women (64% vs 45%, P = .010). In men, no ECG-LVH criteria showed meaningful correlations or discriminative performance for LVM or maxLVWT. Only QRS duration demonstrated discriminative performance (AUROC: LVM 0.67; maxLVWT 0.74). In women, all voltage and product criteria correlated with LVM (ρ = 0.25-0.45) with acceptable discrimination (AUROC: 0.63-0.73). Peguero-Lo Presti, Cornell-, and Modified Sum of 12-Lead Product showed moderate performance (sensitivities: 24%-29%) at 95% specificity in female athletes. Overall, increased precordial QRS voltages were independently correlated with lower extracellular volume (β = -0.3 mV per %ECV, P < .001). CONCLUSION: In elite athletes, ECG-LVH criteria, except for QRS duration, lack diagnostic value for LVH in men. Voltage criteria may have diagnostic potential in women.","is_dataset_classified":null,"base_score":1.6094379124341003,"endowment":1.6094379124341003,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"40345466","pmcid":null,"openalex_id":"https://openalex.org/W4410199213","authors":[],"funders":[{"funder_name":"Amsterdam Movement Sciences","grant_id":"","title":null}],"total_grants":1,"fwci":3.0492,"citation_percentile":0.917688,"influential_citations":0,"citation_trend":[{"year":2025,"count":2},{"year":2026,"count":2}],"oa_status":"hybrid","license":"cc-by","oa_locations":[{"url":"https://doi.org/10.1016/j.hrthm.2025.05.004","host_type":"journal"},{"url":"https://doi.org/10.1016/j.hrthm.2025.05.004","host_type":"publisher"},{"url":"https://api.elsevier.com/content/article/PII:S1547527125024166?httpAccept=text/xml","host_type":"publisher"},{"url":"https://api.elsevier.com/content/article/PII:S1547527125024166?httpAccept=text/plain","host_type":"publisher"},{"url":"https://pubmed.ncbi.nlm.nih.gov/40345466","host_type":"repository"},{"url":"https://pure.eur.nl/en/publications/8a3662e8-b8ec-4509-bae5-f217c97210bc","host_type":"repository"},{"url":"https://pure.amsterdamumc.nl/en/publications/216468b9-bfa2-4e86-9235-743c7471da29","host_type":"repository"},{"url":"https://pure.amsterdamumc.nl/ws/files/142413306/Sex-specific-performance-of-electrocardiographic-criteria-for-left-ventricular-hypertrophy-in-elite-athletes.pdf","host_type":"repository"}],"fields_of_study":["Cardiovascular Effects of Exercise","Cardiac electrophysiology and arrhythmias","Cardiac Imaging and Diagnostics","Humans","Electrocardiography","Hypertrophy, Left Ventricular","Male","Female","Cross-Sectional Studies","Athletes","Adult","Sex Factors","Magnetic Resonance Imaging, Cine","Heart Ventricles","Echocardiography","Young Adult"],"mesh_terms":["Adult","Cross-Sectional Studies","Echocardiography","Electrocardiography","Female","Heart Ventricles","Humans","Male","Sex Factors","Hypertrophy, Left Ventricular","Magnetic Resonance Imaging, Cine","Young Adult","Athletes"],"keywords":["Medicine","Cardiology","Internal medicine","Athletes","Elite athletes","Left ventricular hypertrophy","Elite","Physical therapy","Cardiac","hypertrophy","Sex characteristics","Magnetic resonance imaging (MRI)","Electrocardiography (Ecg)","Left Ventricular (Lvh)"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Gender equality"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-02T20:03:56.270206Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}