Experiences in Cardiovascular Screening of Professional Athletes Using Echocardiography and Electrocardiography at Jakaya Kikwete Cardiac Institute in Tanzania

Experiences in Cardiovascular Screening of Professional Athletes Using Echocardiography and Electrocardiography at Jakaya Kikwete Cardiac Institute in Tanzania | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Experiences in Cardiovascular Screening of Professional Athletes Using Echocardiography and Electrocardiography at Jakaya Kikwete Cardiac Institute in Tanzania Henry Mayala, Lulu Fundikira, Engerasiya Kifai, Aika Nnkya, Dickson Minja, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8290110/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background: Sudden cardiac deaths (SCD) in professional athletes have resulted in a need for cardiovascular screening. There is a general paucity of data regarding screening for SCD risks in African professional athletes, including those in Tanzania. Aim: To determine professional athletes’ electrocardiographic and echocardiographic characteristics. Methodology: A cross-sectional study at Jakaya Kikwete Cardiac Institute in Dar Es Salaam, Tanzania, involved professional athletes from 2021 to 2023 Data on anthropometrics, physical examination, and family history were entered into a standardized questionnaire. All patients underwent 12-lead electrocardiograph (ECG) and two-dimensional echocardiography. Continuous variables were tested for normality using the Kolmogorov-Smirnov test. ECG and echocardiography findings of men and women athletes were compared by using the unpaired Student’s t-test for continuous variables. The chi-square test was used to evaluate the differences in proportions for categorical ECG and echocardiographic findings of men and women athletes. The p-value of <.05 was statistically significant. Results: 86 professional athletes were included, most of whom were men (62%). There was a statistically significant mean difference in men(M) vs women(W) in heart rate (53M vs 60W p<.001), PR interval (176M vs 164W p<.043) and left ventricular internal diameter in diastole (46M vs 41W p<.001). Only two athletes, one man and one woman, had a prolonged QT interval. The most prevalent normal ECG finding in men athletes was early repolarization, and sinus arrhythmia in women athletes. Conclusion: Most of our athletes had normal physiological changes, which are more common in men than women. A few athletes with abnormal findings reinforce the importance of cardiac screening . cardiovascular screening sudden cardiac death professional athletes echocardiography electrocardiography Figures Figure 1 LAY SUMMARY Sudden cardiac death is not uncommon, especially in professional athletes. This study investigated screening of the heart using echocardiography and electrocardiography to identify the presence of heart problems that may lead to sudden cardiac death. Key findings: Most athletes had what are considered normal heart changes seen in people who engage in intense training A few athletes had problems in their hearts, which shows the importance of screening BACKGROUND Sudden cardiac deaths (SCD) in professional athletes have resulted in a need for cardiovascular screening using electrocardiography and echocardiography. The incidence of SCD worldwide is controversial due to a lack of heterogeneous criteria; however, a study in the US has reported the highest incidence of SCD among division I male basketball players (1:8188 [White, 1:5848; Black, 1:7696 athlete-years]). Male sex, Black race, and basketball are associated with a higher incidence of SCD. 1 The incidence of sudden cardiac death is high in African Americans. 1 Inherited cardiac conditions are the most common cause of SCD in young athletes under 35 years. A systematic review done by D’Ascenzi et al. reports that causes of SCD differ in the USA compared to Europe; whereas in the US, most athletes had hypertrophic cardiomyopathy and anomalous origin of coronary arteries, while ACM and channelopathies were more frequent in Europe. 2 There is generally limited data regarding SCD screening in African athletes (reference). Hallak et al. conducted a systematic review on cardiac screening of athletes in the Middle East and Africa, which involved four studies; no women athletes were included in these studies. The review reports commonly known underlying triggers of SCD in athletes in all four studies, including Wolff-Parkinson-White syndrome (WPW), arrhythmogenic right ventricular cardiomyopathy (ARVC), and hypertrophic cardiomyopathy (HCM), whose prevalence ranged between 0.47% and 0.49%. 3 Detecting disease early in asymptomatic athletes through screening is paramount in reducing the risks of sudden cardiac death. 4 However, there is a paucity of published data regarding cardiovascular screening of professional athletes in Tanzania. Screening using 12-lead electrocardiograph (ECG) can detect dangerous arrhythmia and can also be used to differentiate physiological changes related to sports training from features suggestive of an underlying pathological state. 5 Echocardiography plays a vital role in risk assessment for SCD. Two-dimensional echocardiography can elucidate the presence of structural abnormalities such as hypertrophic cardiomyopathy, where ventricular maximal wall thickness left is one of the most important factors. 6 Meanwhile, strain echocardiography may show abnormal myocardial deformation, which indirectly reflects myocardial fibrosis, and may be present clinically as cardiac arrhythmia. 7 This study aims to establish Tanzanian professional athletes’ ECG and echocardiographic characteristics. METHODOLOGY We conducted a cross-sectional observational study at Jakaya Kikwete Cardiac Institute (JKCI) in Dar Es Salaam, Tanzania, involving Tanzanian professional athletes who were footballers preparing for local and international tournaments from 2021 to 2023. We used a continuous sampling method. Definition of a Professional Athlete: A professional athlete is an individual who competes in sports for compensation, participating in official events that can attract varying audience sizes. These athletes may be self-employed or affiliated with sports organizations, and they dedicate significant time to physical training, strategic preparation, and competition. 8 Cardiovascular Screening Height, weight, blood pressure, and HR were measured, and a standardized questionnaire was completed 22 , which cleared the athlete’s personal and family history. A physical examination was also performed. Resting 12-lead Electrocardiography 12-lead ECG was done using GE MAC 2000, the players were positioned supine, and after 5 minutes of rest, ECG was recorded at a standard speed of 25mm /s. ECGs were analyzed and interpreted independently by experienced cardiologists using international criteria for electrocardiographic interpretation in athletes. 9 ,19,20,21 2D-Transthoracic echocardiography A 2-dimensional echocardiography was done using GE Vivid IQ T-9, Siemens Accuson X-300 and Siemens Juniper; standard views were obtained using the American Society of Echocardiography protocol. 10 The images were reviewed and interpreted by experienced cardiologists. Statistical analysis The data were analysed using SPSS software (Chicago, IL; version 20. Continuous variables were tested for normality using the Kolmogorov-Smirnov test. Electrocardiography and echocardiography findings of men and women athletes were compared to evaluate differences between means using the unpaired Student t-test for continuous variables. The X 2 test was used to evaluate the differences in proportions for categorical ECG and echo findings of men and women athletes. The p-value of < .05 is statistically significant. Permission to conduct the study was formally sought from the IRB unit of JKCI, and patients’ consent to participate in the study was also requested and granted. RESULTS Demographic characteristics: Our study cohort comprised 53(62%) men and 33(38%) women Tanzanian professional athletes who were all footballers. The men athletes ranged from 18 to 36 years, and the women athletes ranged from 15 to 29 years. There was a statistically significant mean difference in age (25M vs 21W p < .001), Height (173M vs 162W p < .001), weight (73M vs 58W p < .001), heart rate (53M vs 60W p < .001), PR interval (176M vs 164W p < .043), LVIDd (46M vs 41W p < .001) as shown in Table 1 . Table 1 Demographic, ECG and Echo characteristics of Athletes Male Female P-value Age in Yrs (mean) 25 21 < .001* Height in CM 173 162 < .001* Weight in Kg 73 58 < .001* Heart Rate beats/min 53 60 < .001* PR interval 176 164 < .043* LVEF in % 62 62 < .914 LVIDd in CM 46 41 < .001* LA in CM 31 31 < .769 E/A ratio 1.52 1.47 < .699 TAPSE 19 19 < .792 a P value of < .05 is statistically significant LVEF- left ventricular ejection fraction, LVIDd- Left ventricular internal diameter diastole LA- Left atrium We had two athletes with abnormal ECG findings, seen in one man and one woman, who had a prolonged QT interval. The most prevalent normal ECG finding in men athletes was early repolarization, and sinus arrhythmia in women athletes, as shown in Table 2 . Table 2 ECG FINDINGS ACCORDING TO THE INTERNATIONAL RECOMMENDATION CRITERIA Male (n = 53) Female (n = 33) normal ECG 52 32 Abnormal ECG 1 1 Prolonged PR interval 4 1 Prolonged QT interval 1 1 Early Repolarization 30 9 Sinus Arrhythmia 7 12 Short PR interval 1 Incomplete RBBB 1 We had two abnormal ECG findings one male, one female which was prolonged QT interval. The most prevalent normal ecg finding in male athletes was early repolarization and in female athletes was sinus arrhythmia as shown in Table 2 . DISCUSSION This study explores echocardiographic and electrocardiographic findings of 86 professional athletes (footballers) who attended the Jakaya Kikwete cardiac Institute in Tanzania. Most of these athletes were men at 53(62%). The men athletes’ ages ranged from 18 to 36 years, and the women athletes’ ages ranged from 15 to 29 years. ECG findings Most of the athletes in this study had normal ECG findings except for one man and a woman with prolonged QT interval. There normal ECG findings were in keeping with Ngabea MA et al 11 . a study done in Nigeria whereby, they had ECG characteristics consistent with normal physiological changes Women had more sinus arrhythmia compared to men, which was in keeping with other studies, such as that of OM Corici et al. 12 Sinus bradycardia was found more in men than in women athletes with statistical significance (p < .001*) as reported by Bram Bessem et al. 13 This may be because these athletes had a prolonged time of exercise, as low heart rate is related to an elevated vagal tone secondary to exercise. 14 In sports, a prolonged PR interval is frequent and harmless. Our study found a prolonged PR interval more in men than women, with a significant statistical difference (P < .043*). A study by Sharma et al. revealed a type I atrioventricular block phenomenon in athletes. 15 We also had one woman with a short PR interval, which is common in women than men, in keeping with a study by G-Parry Williams et al. 16 Early repolarization is observed in 25–40% of highly trained sportspersons, more common among men 17 , which is the finding we got in our study that three-quarters of our male athletes had early repolarization compared to women. The study's ECG findings align closely with established physiological adaptations in athlete's heart, where regular endurance training induces benign electrical remodeling such as sinus bradycardia, prolonged PR intervals, and early repolarization due to enhanced vagal tone and structural changes like left ventricular hypertrophy. Sinus bradycardia predominated in male footballers (p < 0.001), reflecting heightened parasympathetic activity from prolonged aerobic exercise, a pattern more pronounced in endurance athletes compared to strength-trained individuals. Early repolarization in 75% of males mirrors the 25–40% prevalence in highly trained athletes, particularly males, driven by myocardial electrophysiological modulation rather than pathology. Gender-specific differences observed—sinus arrhythmia and short PR more common in females—conform to broader patterns where women exhibit distinct autonomic and repolarization responses, including relatively higher resting heart rates and less QRS voltage elevation than men. Prolonged PR intervals in males (p < 0.043) represent harmless first-degree AV block from vagal predominance, while the rare, prolonged QT cases warrant scrutiny to exclude pathology amid these adaptations. These align with international criteria distinguishing training effects from sudden cardiac death risks. Echocardiographic findings Cardiac dimensions- women athletes have lower absolute cardiac dimensions than men athletes 18 . Furthermore, in a study by Sangare et al. 14 they found that women athletes had higher indexed left ventricular diameter; however, in our study, we found that men had higher left ventricular internal diameter in diastole compared to women athletes, and this difference was statistically significant with the P value < 0.001* conforming with Flanagan et al study 18 . Our study showed no difference in left ventricular ejection fraction, right ventricular systolic function and left ventricular diastolic function between men and women athletes. And most of the indices were within normal range. Male athletes' larger absolute left ventricular internal diameters in diastole (p < 0.001) reflect sex-dimorphic remodeling, with men showing greater cavity enlargement from volume overload in sports like football, though indexed values may vary. Female athletes typically exhibit smaller absolute dimensions but relatively larger indexed cavities, preserving normal geometry without exceeding dilated cardiomyopathy thresholds (e.g., LVEDD up to 66 mm in elite females). Preserved ejection fraction, right ventricular function, and diastolic parameters across sexes underscore functional adaptation without systolic or diastolic impairment, consistent with adolescent-to-adult progression were males remodel more extensively post-puberty. CONCLUSION Most athletes exhibited normal ECG and echocardiogram findings consistent with physiological adaptations, which were more prevalent in males than females. A minority with abnormal ECG results highlights the critical need for systematic cardiac screening to mitigate risks of sudden cardiac death from ventricular arrhythmias during intense exertion. These observations reinforce established guidelines on pre-participation cardiovascular evaluation in athletes, emphasizing early detection of at-risk individuals. Future studies should explore gender-specific screening thresholds and longitudinal outcomes in diverse athletic cohorts to refine protocols. Abbreviations List of abbreviations: SCD- sudden cardiac death , ECG- electrocardiography , WPW- Wolff-Parkinson-White syndrome , ARVC- arrhythmogenic right ventricular cardiomyopathy HCM- hypertrophic cardiomyopathy Ethics Approval and consent The study was conducted according to the Helsinki declaration, Ethical approval from JKCI institutional research review board was given. All participants consented to participate Consent for publication All participants consented for publication. Availability of data and materials: The data are available upon request Competing interests The authors declare that there is no competing interests Funding This study did not receive any funding Authors contribution HM, FS, EK, AN, DM collected data, analyzed data, and drafted the manuscript JK, GM, PK, PP, PK reviewed the manuscript HM-Corresponding Author Acknowledgements: Not applicable Declarations Consent for publication - All participants consented for publication. Funding - This study did not receive any funding Author Contribution - HM, EK, FS, AN, DM collected data, analyzed data, and drafted the manuscript- JK, GM, PK, PP, PK reviewed the manuscript- HM-Corresponding Author Acknowledgements: - Not applicable Data Availability The data are available upon request References Petek BJ, Churchill TW, Moulson N, Kliethermes SA, Baggish AL, Drezner JA, Patel MR, Ackerman MJ, Kucera KL, Siebert DM, Salerno L. 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Supplementary Files 14elementAHAcardiovascularscreeningchecklistanddatacollectiontool.pdf Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 24 Mar, 2026 Reviews received at journal 25 Jan, 2026 Reviews received at journal 22 Jan, 2026 Reviewers agreed at journal 21 Jan, 2026 Reviewers agreed at journal 21 Jan, 2026 Reviewers agreed at journal 16 Jan, 2026 Reviewers invited by journal 14 Jan, 2026 Editor assigned by journal 12 Jan, 2026 Editor invited by journal 18 Dec, 2025 Submission checks completed at journal 17 Dec, 2025 First submitted to journal 17 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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09:10:46","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":69201,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8290110/v1/2cd16f457279ac3fd454a608.html"},{"id":100567349,"identity":"eb898294-c386-4899-9f2a-17f9c664024a","added_by":"auto","created_at":"2026-01-19 09:10:46","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":33593,"visible":true,"origin":"","legend":"\u003cp\u003eBox and whiskers plot showing the mean Heart rates between male and female with the outliers\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8290110/v1/1df93b016e64f243ac32f9f0.jpg"},{"id":100597330,"identity":"00bbf1d2-70a2-4db4-87fc-d86b2792c395","added_by":"auto","created_at":"2026-01-19 14:17:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":589209,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8290110/v1/c85bda5e-b29c-457e-95cc-474481f613a5.pdf"},{"id":100567352,"identity":"a1308079-da37-4cae-8bfc-d5181242c176","added_by":"auto","created_at":"2026-01-19 09:10:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":279697,"visible":true,"origin":"","legend":"","description":"","filename":"14elementAHAcardiovascularscreeningchecklistanddatacollectiontool.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8290110/v1/aefa64030e492ed895b8e35d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eExperiences in Cardiovascular Screening of Professional Athletes Using Echocardiography and Electrocardiography at Jakaya Kikwete Cardiac Institute in Tanzania\u003c/p\u003e","fulltext":[{"header":"LAY SUMMARY","content":"\u003cp\u003eSudden cardiac death is not uncommon, especially in professional athletes. This study investigated screening of the heart using echocardiography and electrocardiography to identify the presence of heart problems that may lead to sudden cardiac death.\u003c/p\u003e\n\u003cp\u003eKey findings:\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eMost athletes had what are considered normal heart changes seen in people who engage in intense training\u003c/li\u003e\n \u003cli\u003eA few athletes had problems in their hearts, which shows the importance of screening\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"BACKGROUND","content":"\u003cp\u003eSudden cardiac deaths (SCD) in professional athletes have resulted in a need for cardiovascular screening using electrocardiography and echocardiography. The incidence of SCD worldwide is controversial due to a lack of heterogeneous criteria; however, a study in the US has reported the highest incidence of SCD among division I male basketball players (1:8188 [White, 1:5848; Black, 1:7696 athlete-years]). Male sex, Black race, and basketball are associated with a higher incidence of SCD. \u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe incidence of sudden cardiac death is high in African Americans. \u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eInherited cardiac conditions are the most common cause of SCD in young athletes under 35 years. A systematic review done by D\u0026rsquo;Ascenzi et al. reports that causes of SCD differ in the USA compared to Europe; whereas in the US, most athletes had hypertrophic cardiomyopathy and anomalous origin of coronary arteries, while ACM and channelopathies were more frequent in Europe.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThere is generally limited data regarding SCD screening in African athletes (reference). Hallak et al. conducted a systematic review on cardiac screening of athletes in the Middle East and Africa, which involved four studies; no women athletes were included in these studies. The review reports commonly known underlying triggers of SCD in athletes in all four studies, including Wolff-Parkinson-White syndrome (WPW), arrhythmogenic right ventricular cardiomyopathy (ARVC), and hypertrophic cardiomyopathy (HCM), whose prevalence ranged between 0.47% and 0.49%.\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDetecting disease early in asymptomatic athletes through screening is paramount in reducing the risks of sudden cardiac death.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHowever, there is a paucity of published data regarding cardiovascular screening of professional athletes in Tanzania.\u003c/p\u003e \u003cp\u003eScreening using 12-lead electrocardiograph (ECG) can detect dangerous arrhythmia and can also be used to differentiate physiological changes related to sports training from features suggestive of an underlying pathological state.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEchocardiography plays a vital role in risk assessment for SCD. Two-dimensional echocardiography can elucidate the presence of structural abnormalities such as hypertrophic cardiomyopathy, where ventricular maximal wall thickness left is one of the most important factors.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMeanwhile, strain echocardiography may show abnormal myocardial deformation, which indirectly reflects myocardial fibrosis, and may be present clinically as cardiac arrhythmia. \u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eThis study aims to establish Tanzanian professional athletes\u0026rsquo; ECG and echocardiographic characteristics.\u003c/em\u003e \u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003e We conducted a cross-sectional observational study at Jakaya Kikwete Cardiac Institute (JKCI) in Dar Es Salaam, Tanzania, involving Tanzanian professional athletes who were footballers preparing for local and international tournaments from 2021 to 2023. We used a continuous sampling method.\u003c/p\u003e \u003cp\u003eDefinition of a Professional Athlete:\u003c/p\u003e \u003cp\u003eA professional athlete is an individual who competes in sports for compensation, participating in official events that can attract varying audience sizes. These athletes may be self-employed or affiliated with sports organizations, and they dedicate significant time to physical training, strategic preparation, and competition.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCardiovascular Screening\u003c/p\u003e \u003cp\u003eHeight, weight, blood pressure, and HR were measured, and a standardized questionnaire was completed\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e, which cleared the athlete\u0026rsquo;s personal and family history. A physical examination was also performed.\u003c/p\u003e \u003cp\u003eResting 12-lead Electrocardiography\u003c/p\u003e \u003cp\u003e12-lead ECG was done using GE MAC 2000, the players were positioned supine, and after 5 minutes of rest, ECG was recorded at a standard speed of 25mm /s. ECGs were analyzed and interpreted independently by experienced cardiologists using international criteria for electrocardiographic interpretation in athletes. \u003csup\u003e9 ,19,20,21\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e2D-Transthoracic echocardiography\u003c/p\u003e \u003cp\u003eA 2-dimensional echocardiography was done using GE Vivid IQ T-9, Siemens Accuson X-300 and Siemens Juniper; standard views were obtained using the American Society of Echocardiography protocol.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e The images were reviewed and interpreted by experienced cardiologists.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe data were analysed using SPSS software (Chicago, IL; version 20. Continuous variables were tested for normality using the Kolmogorov-Smirnov test. Electrocardiography and echocardiography findings of men and women athletes were compared to evaluate differences between means using the unpaired Student t-test for continuous variables. The X\u003csup\u003e2\u003c/sup\u003e test was used to evaluate the differences in proportions for categorical ECG and echo findings of men and women athletes. The p-value of \u0026lt;\u0026thinsp;.05 is statistically significant.\u003c/p\u003e \u003cp\u003ePermission to conduct the study was formally sought from the IRB unit of JKCI, and patients\u0026rsquo; consent to participate in the study was also requested and granted.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eDemographic characteristics:\u003c/p\u003e \u003cp\u003eOur study cohort comprised 53(62%) men and 33(38%) women Tanzanian professional athletes who were all footballers. The men athletes ranged from 18 to 36 years, and the women athletes ranged from 15 to 29 years. There was a statistically significant mean difference in age (25M vs 21W p\u0026thinsp;\u0026lt;\u0026thinsp;.001), Height (173M vs 162W p\u0026thinsp;\u0026lt;\u0026thinsp;.001), weight (73M vs 58W p\u0026thinsp;\u0026lt;\u0026thinsp;.001), heart rate (53M vs 60W p\u0026thinsp;\u0026lt;\u0026thinsp;.001), PR interval (176M vs 164W p\u0026thinsp;\u0026lt;\u0026thinsp;.043), LVIDd (46M vs 41W p\u0026thinsp;\u0026lt;\u0026thinsp;.001) as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic, ECG and Echo characteristics of Athletes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in Yrs (mean)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight in CM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight in Kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart Rate beats/min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePR interval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.043*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF in %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.914\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVIDd in CM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLA in CM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.769\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE/A ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.699\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTAPSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.792\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ea P value of \u0026lt;\u0026thinsp;.05 is statistically significant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eLVEF- left ventricular ejection fraction, LVIDd- Left ventricular internal diameter diastole\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLA- Left atrium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe had two athletes with abnormal ECG findings, seen in one man and one woman, who had a prolonged QT interval. The most prevalent normal ECG finding in men athletes was early repolarization, and sinus arrhythmia in women athletes, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eECG FINDINGS ACCORDING TO THE INTERNATIONAL RECOMMENDATION CRITERIA\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale (n\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale (n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enormal ECG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbnormal ECG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProlonged PR interval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProlonged QT interval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEarly Repolarization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSinus Arrhythmia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShort PR interval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncomplete RBBB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe had two abnormal ECG findings one male, one female which was prolonged QT interval. The most prevalent normal ecg finding in male athletes was early repolarization and in female athletes was sinus arrhythmia as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study explores echocardiographic and electrocardiographic findings of 86 professional athletes (footballers) who attended the Jakaya Kikwete cardiac Institute in Tanzania. Most of these athletes were men at 53(62%). The men athletes\u0026rsquo; ages ranged from 18 to 36 years, and the women athletes\u0026rsquo; ages ranged from 15 to 29 years.\u003c/p\u003e\n\u003ch3\u003eECG findings\u003c/h3\u003e\n\u003cp\u003eMost of the athletes in this study had normal ECG findings except for one man and a woman with prolonged QT interval. There normal ECG findings were in keeping with Ngabea MA et al\u003csup\u003e11\u003c/sup\u003e. a study done in Nigeria whereby, they had ECG characteristics consistent with normal physiological changes\u003c/p\u003e \u003cp\u003eWomen had more sinus arrhythmia compared to men, which was in keeping with other studies, such as that of OM Corici et al.\u003csup\u003e12\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSinus bradycardia was found more in men than in women athletes with statistical significance (p\u0026thinsp;\u0026lt;\u0026thinsp;.001*) as reported by Bram Bessem et al.\u003csup\u003e13\u003c/sup\u003e This may be because these athletes had a prolonged time of exercise, as low heart rate is related to an elevated vagal tone secondary to exercise.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn sports, a prolonged PR interval is frequent and harmless. Our study found a prolonged PR interval more in men than women, with a significant statistical difference (P\u0026thinsp;\u0026lt;\u0026thinsp;.043*). A study by Sharma et al. revealed a type I atrioventricular block phenomenon in athletes.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e We also had one woman with a short PR interval, which is common in women than men, in keeping with a study by G-Parry Williams et al.\u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEarly repolarization is observed in 25\u0026ndash;40% of highly trained sportspersons, more common among men\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e, which is the finding we got in our study that three-quarters of our male athletes had early repolarization compared to women.\u003c/p\u003e \u003cp\u003eThe study's ECG findings align closely with established physiological adaptations in athlete's heart, where regular endurance training induces benign electrical remodeling such as sinus bradycardia, prolonged PR intervals, and early repolarization due to enhanced vagal tone and structural changes like left ventricular hypertrophy. Sinus bradycardia predominated in male footballers (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), reflecting heightened parasympathetic activity from prolonged aerobic exercise, a pattern more pronounced in endurance athletes compared to strength-trained individuals. Early repolarization in 75% of males mirrors the 25\u0026ndash;40% prevalence in highly trained athletes, particularly males, driven by myocardial electrophysiological modulation rather than pathology.\u003c/p\u003e \u003cp\u003eGender-specific differences observed\u0026mdash;sinus arrhythmia and short PR more common in females\u0026mdash;conform to broader patterns where women exhibit distinct autonomic and repolarization responses, including relatively higher resting heart rates and less QRS voltage elevation than men. Prolonged PR intervals in males (p\u0026thinsp;\u0026lt;\u0026thinsp;0.043) represent harmless first-degree AV block from vagal predominance, while the rare, prolonged QT cases warrant scrutiny to exclude pathology amid these adaptations. These align with international criteria distinguishing training effects from sudden cardiac death risks.\u003c/p\u003e\n\u003ch3\u003eEchocardiographic findings\u003c/h3\u003e\n\u003cp\u003eCardiac dimensions- women athletes have lower absolute cardiac dimensions than men athletes\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Furthermore, in a study by Sangare et al.\u003csup\u003e14\u003c/sup\u003e they found that women athletes had higher indexed left ventricular diameter; however, in our study, we found that men had higher left ventricular internal diameter in diastole compared to women athletes, and this difference was statistically significant with the P value\u0026thinsp;\u0026lt;\u0026thinsp;0.001* conforming with Flanagan et al study\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOur study showed no difference in left ventricular ejection fraction, right ventricular systolic function and left ventricular diastolic function between men and women athletes. And most of the indices were within normal range.\u003c/p\u003e \u003cp\u003eMale athletes' larger absolute left ventricular internal diameters in diastole (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) reflect sex-dimorphic remodeling, with men showing greater cavity enlargement from volume overload in sports like football, though indexed values may vary. Female athletes typically exhibit smaller absolute dimensions but relatively larger indexed cavities, preserving normal geometry without exceeding dilated cardiomyopathy thresholds (e.g., LVEDD up to 66 mm in elite females). Preserved ejection fraction, right ventricular function, and diastolic parameters across sexes underscore functional adaptation without systolic or diastolic impairment, consistent with adolescent-to-adult progression were males remodel more extensively post-puberty.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eMost athletes exhibited normal ECG and echocardiogram findings consistent with physiological adaptations, which were more prevalent in males than females. A minority with abnormal ECG results highlights the critical need for systematic cardiac screening to mitigate risks of sudden cardiac death from ventricular arrhythmias during intense exertion.\u003c/p\u003e \u003cp\u003e These observations reinforce established guidelines on pre-participation cardiovascular evaluation in athletes, emphasizing early detection of at-risk individuals. Future studies should explore gender-specific screening thresholds and longitudinal outcomes in diverse athletic cohorts to refine protocols.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cem\u003eList of abbreviations:\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSCD-\u003cem\u003esudden cardiac death\u003c/em\u003e,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eECG-\u003cem\u003eelectrocardiography\u003c/em\u003e,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWPW- \u003cem\u003eWolff-Parkinson-White syndrome\u003c/em\u003e,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eARVC-\u003cem\u003earrhythmogenic right ventricular cardiomyopathy\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;HCM-\u003cem\u003ehypertrophic cardiomyopathy\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthics Approval and consent\u003c/em\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe study was conducted according to the Helsinki declaration, Ethical approval from JKCI institutional research review board was given. All participants consented to participate\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eAll participants consented for publication.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials:\u003c/em\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe data are available upon request\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe authors declare that there is no competing interests\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThis study did not receive any funding\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cem\u003eAuthors contribution\u003c/em\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eHM, FS, EK, AN, DM collected data, analyzed data, and drafted the manuscript\u003c/li\u003e\n \u003cli\u003eJK, GM, PK, PP, PK reviewed the manuscript\u003c/li\u003e\n \u003cli\u003eHM-Corresponding Author\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements:\u003c/em\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eNot applicable\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e- All participants consented for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e- This study did not receive any funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e- HM, EK, FS, AN, DM collected data, analyzed data, and drafted the manuscript- JK, GM, PK, PP, PK reviewed the manuscript- HM-Corresponding Author\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e- Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are available upon request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePetek BJ, Churchill TW, Moulson N, Kliethermes SA, Baggish AL, Drezner JA, Patel MR, Ackerman MJ, Kucera KL, Siebert DM, Salerno L. 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PMID: 25223981.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"cardiovascular screening, sudden cardiac death, professional athletes, echocardiography, electrocardiography","lastPublishedDoi":"10.21203/rs.3.rs-8290110/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8290110/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eSudden cardiac deaths (SCD) in professional athletes have resulted in a need for cardiovascular screening. There is a general paucity of data regarding screening for SCD risks in African professional athletes, including those in Tanzania.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim: To\u003c/strong\u003e determine professional athletes’ electrocardiographic and echocardiographic characteristics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology: \u003c/strong\u003eA cross-sectional study at Jakaya Kikwete Cardiac Institute in Dar Es Salaam, Tanzania, involved professional athletes from 2021 to 2023 Data on anthropometrics, physical examination, and family history were entered into a standardized questionnaire. All patients underwent 12-lead electrocardiograph (ECG) and two-dimensional echocardiography. Continuous variables were tested for normality using the Kolmogorov-Smirnov test. ECG and echocardiography findings of men and women athletes were compared by using the unpaired Student’s t-test for continuous variables. The chi-square test was used to evaluate the differences in proportions for categorical ECG and echocardiographic findings of men and women athletes. The p-value of \u0026lt;.05 was statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003e86 professional athletes were included, most of whom were men (62%). There was a statistically significant mean difference in men(M) vs women(W) in heart rate (53M vs 60W p\u0026lt;.001), PR interval (176M vs 164W p\u0026lt;.043) and left ventricular internal diameter in diastole (46M vs 41W p\u0026lt;.001). Only two athletes, one man and one woman, had a prolonged QT interval. The most prevalent normal ECG finding in men athletes was early repolarization, and sinus arrhythmia in women athletes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eMost of our athletes had normal physiological changes, which are more common in men than women. A few athletes with abnormal findings reinforce the importance of cardiac screening\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e","manuscriptTitle":"Experiences in Cardiovascular Screening of Professional Athletes Using Echocardiography and Electrocardiography at Jakaya Kikwete Cardiac Institute in Tanzania","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-19 09:10:41","doi":"10.21203/rs.3.rs-8290110/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-24T06:44:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-25T11:31:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-22T09:50:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"212936102923933914173349568731665276726","date":"2026-01-22T00:37:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"136014777607841744549649148619412904709","date":"2026-01-21T18:56:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"123353874499003423087540982226597405937","date":"2026-01-16T12:19:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-14T09:40:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-13T04:59:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-18T13:39:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-17T13:46:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-12-17T13:37:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"57e8aa92-fad1-455f-8087-1ddd591a8506","owner":[],"postedDate":"January 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-16T10:08:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-19 09:10:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8290110","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8290110","identity":"rs-8290110","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}