Impact of geographical origin upon the electrical and structural manifestations of the black athlete’s heart

It is known that black athletes have an increased prevalence of left ventricular hypertrophy (LVH) on echocardiography and are more likely to have repolarization anomalies when compared with white athletes. It is not known whether this increased rate is universal, or whether substantial differences exist according to a player’s geographic origin. The aim of this study was to examine the impact of geographical origin upon the electrical—and structural manifestations of the black athlete’s heart.1.

Pre-competition medical assessments (PCMA’s) are a mandatory requirement for all football players participating in FIFA competitions (and in many other leagues and competitions around the world). One of the aims of this assessment is to identify athletes with underlying pathology that could potentially lead to sudden cardiac arrest/death. This process is not perfect however and may on occasion be complicated by the difficulty in distinguishing between pathological and physiological remodelling of the heart. This can be particularly challenging in black athletes where there can be a five-fold increase in the prevalence of left ventricular hypertrophy (LVH) on echocardiography and a six-fold increase in the prevalence of repolarisation anomalies.

This study involved a total of 1698 male competitive athletes participating in mixed sports (50% were football players) who presented to the Aspetar FIFA Medical Centre of Excellence for PCMA screening. A total 72% of these players underwent echocardiography. Athletes were categorized by United Nations defined geographical regions. From this we found that the prevalence of an abnormal ECG suggestive of cardiac pathology did vary by geographical origin. Left ventricular hypertrophy was significantly more common among African American/Caribbean (9.5%) and West African (5%) athletes when compared to West Asian (0.8%), East African (0%) and North African (0%) athletes. Equally, repolarization abnormalities were the most common form of ECG abnormality and were significantly more prevalent among West (6.4%) and Middle African (8.5%) athletes than East (1.5%) and North Africans (1.2%).

The precise mechanism for these differences is currently unknown, however, it is clear that the hearts of all black athletes are not necessarily universally comparable and a multi-continental longitudinal study in a larger cohort of athletes should be performed to assess the precise significance of these findings. This study illustrates the importance of understanding what is actually ‘normal’ for an individual player and the need to consider this when performing a PCMA.

To learn more about the PCMA and cardiac issues in football players complete the Cardiology and PCMA modules in the FIFA Football Medicine Diploma.

1. Riding NR, Sharma S, McClean G, et al. 2018. Impact of geographical origin upon the electrical and structural manifestations of the black athlete’s heart. European heart journal. (Online First)


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La FIFA et la CAF ont rendu obligatoire le PCMA ( examen pré compétition et assesment) pendant les phases finales.. Ces examens ont pour but de connaître le statut CARDIO VASCULAIRE du sportif afin d éviter les morts subites. Au cour des examens on peux rencontre des cas physiologiques donc héréditaires des cas acquis enfin pathologiques comme ce cas d hypertrophie ventriculaire gauche.chez les noirs. Les drepanocytaires vivent très mal en altitude par faute d hypoxie