To assess the value of echocardiography combined with electrocardiogram (ECG) in predicting left ventricular hypertrophy among high-level swimming athletes in a university.

A retrospective analysis was conducted on 152 college students selected from Beijing Foreign Studies University from January 2019 to December 2020. including 40 high-level swimmers as an athlete group, and 112 ordinary college students who participated in volleyball, tennis, football, or track and field competitions during the same period as a control group. All students underwent ECG examination. Cardiac ultrasound examination was performed on all high-level athletes and ordinary college students whose ECG indicated high left ventricular voltage.

Among the 152 study subjects included, 16 had left ventricular high voltage on ECG. Further ultrasound examinations were conducted on 40 high-level athletes and 8 ordinary college students with abnormal electrocardiogram. Among them, 8 ordinary college students with abnormal electrocardiogram showed no significant abnormalities in left heart structure and systolic function on resting state echocardiography. Among 40 high-level athletes, 21 (52.5%) had ECG indicating left ventricular enlargement or fullness. The aortic root diameter (AoD), left atrial anteroposterior diameter (LAAPD), left ventricular end diastolic septal thickness (IVSd), left ventricular end diastolic posterior wall thickness (LVPWd), left ventricular end diastolic anteroposterior diameter (LVEDD), left ventricular end systolic anteroposterior diameter (LVESD), left ventricular myocardial weight (LVM), and left ventricular myocardial mass index (LVMI) of athletes were all significantly higher than those of ordinary college students (P<0.05), but athletes had significantly lower left ventricular ejection fraction (LVEF) and left ventricular shortening fraction (LVFS) than ordinary college students (P<0.05).

The positive rate of pure left ventricular high voltage on ECG is low, and high-level swimmers have a higher positive rate of left ventricular abnormalities diagnosed by ECG. Doctors should be cautious when making conclusions about ventricular hypertrophy by ECG diagnosis.