Abstract
BACKGROUND: Major League Soccer (MLS) is composed of an ethnically diverse athlete population for which electrocardiogram (ECG) analysis has not been previously reported. OBJECTIVES: This paper evaluated MLS player ECGs and characterized ECGs as having normal, borderline, and/or abnormal ECG findings based on the international criteria. Echocardiographic data were analyzed when history, physical, or ECG findings were abnormal. METHODS: This was a cross-sectional study of MLS players from 2017 to 2020. RESULTS: A total of 706 athletes were included in this study. Athletes were predominantly Caucasian 346 (49%), followed by Black, 85 (26%), and Hispanic, 175 (25%). The mean (SD) age was 24.5 (4.3) years with an age range of 15 to 37 years. The most common abnormal ECG finding was T wave inversion (TWI) (total percent of TWI). Black athletes had a greater proportion of ECGs with any isolated TWI, with 11.9%, compared to Caucasian (5.2%, P = 0.005) and Hispanic (5.7%, P = 0.040) athletes. Subgroup analysis of those with abnormal TWI revealed mostly structurally normal hearts. The most common borderline finding was left axis deviation, with Black athletes having a statistically greater proportion of left axis deviation when compared to Caucasian athletes (3.8% vs 1.2%, P = 0.043). Training-related ECG changes are highly prevalent among professional male soccer players regardless of race. CONCLUSIONS: The most common ECG abnormality and borderline finding per international criteria are TWI and left atrial enlargement, respectively. Both were more prevalent in Black athletes. Echocardiography did not reveal underlying cardiovascular disease during follow-up even in the presence of abnormal ECG findings.