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Journal article
Sex differences in ECGs of trained athletes: A systematic review and meta-analysis
European journal of preventive cardiology
01/20/2026
PMID: 41557583
Web of Science ID: WOS:001669805200001
Abstract
To describe and quantify sex differences in the screening electrocardiograms (ECG) of athletes.
Five databases (MEDLINE, EMBASE, Scopus, SPORTDiscus and Web of Science) were searched from inception until October 2024. Included studies were original research articles examining athletes aged 16-40 years, who had a 12-lead screening ECG, and where analysis was stratified by sex. Risk of bias was assessed using a validated tool. A meta-analysis was performed, using a random-effects model, assessing proportions of athlete normal, borderline and abnormal ECG features (according to the 2017 International Criteria) and several ECG measurements.
Eighty-five cross-sectional studies were included. The studies comprised 19,069 female athletes (mean age 20.6±2.8 years) and 57,745 male athletes (mean age 21.3±3.1 years). Female athletes were more likely to have abnormal T-wave inversion (TWI) (OR 2.3, 95% CI: 1.5-3.5), and isolated TWIV1-V3 (OR 5.6, 95% CI: 3.2-9.9) compared to males. No female athletes and two male athletes with isolated TWIV1-V3 were diagnosed with a condition associated with sudden cardiac arrest or death (both male athletes diagnosed with arrhythmogenic cardiomyopathy). Female athletes were also more likely to have an abnormal ECG per the International Criteria, though the finding was not statistically significant (OR 1.3, 95% CI: 0.7-2.4). Female athletes had a 16ms (95% CI 4-27ms) longer QTc interval than male athletes.
Compared to male athletes, female athletes were twice as likely to have abnormal TWI and six times as likely to have isolated TWIV1-V3, a finding which was not accompanied by diagnoses of cardiac pathology in female athletes. These data should help inform sex-specific aspects of athlete ECG screening guidelines.
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Details
- Title
- Sex differences in ECGs of trained athletes
- Publication Details
- European journal of preventive cardiology
- Resource Type
- Journal article
- Publisher
- Oxford University Press
- Number of pages
- 15
- Grant note
- Australian Government Research Training Program (RTP)Heart Foundation Future Leader Fellowship: #107244 National Health and Medical Research Council: 2016730 National Health and Medical Research Council (NHMRC): 2016730
This research received no specific funding. A.J.D. is supported by an Australian Government Research Training Program (RTP) Scholarship through the University of Sydney. B.G. is the recipient of a Heart Foundation Future Leader Fellowship (#107244). J.J.O. is funded by a National Health and Medical Research Council Investigator Grant (No. 2016730).
- Copyright
- © The Author(s) 2026.
- Identifiers
- WOS:001669805200001; 99381602404006600
- Academic Unit
- Usha Kundu, MD College of Health; Movement Sciences and Health
- Language
- English