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June 12, 2026European Journal of Preventive CardiologyOpen Access

Low QRS voltage in paralympic athletes: an unexpectedly high prevalence

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Population

193 elite Italian Paralympic athletes preparing for the Paris 2024 and Milano-Cortina 2026 Olympic Games…

Design

Cohort

Follow-up

8.3 ± 4.2 years

Authors

AFA FerreraGGG Di GioiaVMV Maestrini

Discussion

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Overview

LQRSV may reflect non-pathologic adaptation in Paralympic athletes; leaves open its prognostic value and need for targeted evaluation.

Key Points

  • The study aims to determine the prevalence of low QRS voltage (LQRSV) in elite Paralympic athletes and its association with cardiac abnormalities.
  • Evaluated 193 elite Italian Paralympic athletes
  • Conducted 12-lead ECG, echocardiography, and cardiopulmonary exercise testing
  • Compared clinical characteristics between athletes with and without LQRSV
  • LQRSV identified in 22 athletes (11.4%), predominantly in those with spinal cord injury (27.6%)
  • Athletes with LQRSV showed significantly reduced exercise performance (VO2 max 23.1 vs. 37 ml/min/kg; p<0.0001)
  • No major cardiac abnormalities were found in athletes with LQRSV over medium-term follow-up (8.3 ± 4.2 years).

Structured PICO

P
Population
193 elite Italian Paralympic athletes preparing for the Paris 2024 and Milano-Cortina 2026 Olympic Games, mean age 32.7±9.7 years, 44% females.
C
Comparator
Athletes without low QRS voltage (normal ECG voltages)
O
Outcome
Prevalence of low QRS voltage (LQRSV) and its association with structural cardiac abnormalities or cardiomyopathysurrogate

Low QRS voltage is unexpectedly common in Paralympic athletes, particularly those with spinal cord injury, and appears to reflect a benign physiological cardiac phenotype rather than underlying cardiomyopathy.

Cite This Study

Ferrera et al. (2026) studied this question.

synapsesocial.com/papers/6a2bd11d6550ea4541ffe8c9https://doi.org/10.1093/eurjpc/zwag249.374
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Increased qrs voltages could be a promising factor to differentiate between CMR-matched elite athletes and dilated cardiomyopathy gene carriers2026
  2. 2QRS fragmentation on the 12-lead electrocardiogram and its association to physiological cardiac adaptation in elite cyclists2026
  3. 3Ventricular arrhythmias in athletes: morphologic features and risk stratification of pathological myocardial substrate2026
  4. 4Long QT syndrome in paediatric patients: a single-centre perspective2026
  5. 5An unusual case of persistent very low-voltage electrocardiography2026