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Electrocardiographic Findings in National Basketball Association Athletes

Study researchers and article authors

David J. Engel, MD  Marc P. Waase, MD, PhD; R. Kannan Mutharasan, MD; William Whang, MD; Marco R. DiTullio, MD; John P. DiFioiri, MD; Lisa Callahan, MD; Jimmie Mancell, MD; Dermot Phelan, MD, PhD; Allan Schwartz, MD; Shunichi Homma, MD;


The stated goal of this study was “To generate normative ECG data for National Basketball Association (NBA) athletes and to assess the accuracy of athlete ECG interpretation criteria in this population.”

In order to achieve this goal, researchers examined the preseason ECG examinations from 519 male NBA athletes who had either participated in the 2013-2014 or 2014-2015 seasons and those who had participated in the 2014 and 2015 NBA predraft combines. The study took place between December 2015 and March 2017.

Each ECG was analyzed against 3 existing criteria for interpreting ECG data from athletes. These criteria were as follows: Seattle, refined, and international. The study encountered the following results:

  • 89 percent of participants presented with what the study described as “physiologic, training-related changes” in their ECG examinations.
  • The percentage of abnormal findings decreased with each successive criteria as follows: The 2012 Seattle criteria found 25.2 percent abnormal findings; the refined criteria found 20.8 percent, and the international criteria found 15.6 percent.
  • More abnormal ECG classifications occurred among the older athletes than among the younger ones.
  • Abnormal ECG findings were equally present in African American and in white athletes.
  • Abnormal T-wave inversions (TWIs) were the most common abnormal ECG finding among the NBA athletes, affecting 6.2 percent of the study’s participants.
  • Abnormal ECG findings were not related to the size of the athlete nor to size of the left ventricle or the left ventricle’s cavity.
  • These findings, however, were related the relative wall thickness (RWT) of the left ventricle. 25.2 percent of athletes with the highest RWTs had abnormal ECG findings as compared to 9.3 percent of athletes with the lowest RWTs.
  • T-wave inversions increased as the size of the left ventricular cavity size decreased and the relative thickness of the left ventricle wall increased.
  • Abnormal ECG findings were more common among the NBA athletes than among athletes in other sports.
  • That fact, combined with the older age of the athletes in the study (average age was 24.8) and the increased presence of abnormal ECG findings in the older athletes in the study, indicate that age and athletic experience may influence the changes that occur in the hearts of athletes.
  • Left ventricular cavity size and relative wall thickness of the left ventricle appear to be the most important factors influencing whether or not an athlete presents with abnormal ECG findings.

As a result of these findings, the study concluded that there is still a high rate of abnormal ECG classifications among NBA athletes, despite the improvements demonstrated by successive criteria. The authors recommended further study to understand these abnormal ECG findings. The authors did recommend that the study’s results not be applied to athletes in other sports and noted the absence of comparative data for non athletes with similar physical measurements.