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June 12, 2026European Journal of Preventive CardiologyOpen Access

Increased qrs voltages could be a promising factor to differentiate between CMR-matched elite athletes and dilated cardiomyopathy gene carriers

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Why the study?

Can ECG QRS voltages differentiate between elite athletes and dilated cardiomyopathy gene carriers with similar 'grey zone' CMR parameters?

Population

66 individuals, 1:1 CMR-matched for increased LVEDVi and/or slightly reduced LVEF, 42.4% women.

Comparison

ECG QRS voltage analysis vs Elite athletes vs. DCM gene carriers

Design

Cross-sectional

Key result

QRS voltage independently differentiated mild dilated cardiomyopathy gene carriers from CMR-matched elite athletes (AUC 0.842; 95% CI 0.724-0.960; P=0.008).

Authors

BAB J AdemaMDM A Van DiepenHHH El Hri

Discussion

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Overview

May aid ECG differentiation of athletes from DCM carriers; leaves open prospective validation before clinical adoption.

Key Points

  • The aim is to determine if ECG findings can help differentiate between elite athletes and DCM carriers with similar heart metrics.
  • Cross-sectional study with 33 matched elite athletes and 33 DCM-gene carriers based on LVEDVi and LVEF.
  • ECG findings analyzed against 2018 guidelines; decision tree and logistic regression employed for assessment.
  • QRS voltages calculated without body surface area correction.
  • Elite athletes displayed higher QRS voltages (20.29 mV) compared to DCM-GC (14.53 mV, p=.005).
  • The AUC for logistic regression was 0.842, indicating strong differentiative ability of QRS voltage.
  • Sensitivity was 62% and specificity was 95% with a cutoff of 13.52 mV for QRS voltage.

Study Design

Type

Cross-Sectional (n=66)

Structured PICO

Can ECG QRS voltages differentiate between elite athletes and dilated cardiomyopathy gene carriers with similar 'grey zone' CMR parameters?

P
Population
66 CMR-matched elite athletes and mild dilated cardiomyopathy gene carriers (>16 years old) with similar LVEDVi and LVEF.
E
Exposure
ECG QRS voltage analysis
C
Comparator
Elite athletes vs. DCM gene carriers
O
Outcome
Differentiation between elite athletes and DCM gene carrierssurrogate

Main Result

Effect estimate: AUC 0.842 (95% CI 0.724-0.960)

p-value: p=0.008

Lower QRS voltages (≤13.52 mV) can help differentiate mild dilated cardiomyopathy from exercise-induced cardiac remodelling in athletes when CMR parameters are in the diagnostic grey zone.

Cite This Study

Adema et al. (2026) conducted a cross-sectional in Mild dilated cardiomyopathy vs exercise-induced cardiac remodelling (n=66). QRS voltage vs. Elite athletes was evaluated on Differentiation between DCM-GC and elite athletes (group status) (AUC 0.842, 95% CI 0.724-0.960, p=0.008). QRS voltage independently differentiated mild dilated cardiomyopathy gene carriers from CMR-matched elite athletes (AUC 0.842; 95% CI 0.724-0.960; P=0.008).

synapsesocial.com/papers/6a2bd1386550ea4541ffe9b8https://doi.org/10.1093/eurjpc/zwag249.388
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Also Consider

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

  1. 1The diagnostic accuracy of contemporary ECG interpretation criteria in risk stratification of master athletes2025 · 1 citations
  2. 2Cardiovascular magnetic resonance to differentiate veteran athlete’s heart with cavity dilatation and mild dilated cardiomyopathy2025 · 4 citations
  3. 3Mapping the electrical impact of exercise on disease trajectory in arrhythmogenic cardiomyopathy: a longitudinal ECG study2026
  4. 4Prevalence and relation to training of electrocardiographic findings in Caucasian children and adolescents 8-18 year-old practicing competitive sport.2025 · 4 citations
  5. 5Enhancing differential diagnosis of IHD and DCM using interpretable machine learning in mildly reduced ejection fraction2025 · 1 citations