{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:50:26Z","timestamp":1792003826812,"version":"4.4.0"},"reference-count":117,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Australian Government Research Training Program"},{"name":"Heart Foundation Future Leader Fellowship","award":["#107244"],"award-info":[{"award-number":["#107244"]}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["2016730"],"award-info":[{"award-number":["2016730"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To describe and quantify sex differences in the screening electrocardiograms (ECGs) of athletes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Five databases (MEDLINE, EMBASE, Scopus, SPORTDiscus, and Web of Science) were searched from inception until October 2024. Included studies were original research articles examining athletes aged 16\u201340\u2005years, who had a 12-lead screening ECG, and where analysis was stratified by sex. Risk of bias was assessed using a validated tool. A meta-analysis was performed, using a random-effects model, assessing proportions of athlete normal, borderline, and abnormal ECG features (according to the 2017 International Criteria) and several ECG measurements. Eighty-five cross-sectional studies were included. The studies comprised 19 069 female athletes (mean age 20.6 \u00b1 2.8\u2005years) and 57 745 male athletes (mean age 21.3 \u00b1 3.1\u2005years). Female athletes were more likely to have abnormal T-wave inversion (TWI) (OR 2.3, 95% CI: 1.5\u20133.5), and isolated TWIV1\u2013V3 (OR 5.6, 95% CI: 3.2\u20139.9) compared with males. No female athletes and two male athletes with isolated TWIV1\u2013V3 were diagnosed with a condition associated with sudden cardiac arrest or death (both male athletes diagnosed with arrhythmogenic cardiomyopathy). Female athletes were also more likely to have an abnormal ECG per the International Criteria, though the finding was not statistically significant (OR 1.3, 95% CI: 0.7\u20132.4). Female athletes had a 16\u2005ms (95% CI: 4\u201327\u2005ms) longer QTc interval than male athletes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Compared with male athletes, female athletes were twice as likely to have abnormal TWI and six times as likely to have isolated TWIV1\u2013V3, a finding which was not accompanied by diagnoses of cardiac pathology in female athletes. These data should help inform sex-specific aspects of athlete ECG screening guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Lay summary<\/jats:title>\n                    <jats:p>This paper describes sex differences in athlete screening electrocardiograms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key findings<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwag004","type":"journal-article","created":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T12:23:23Z","timestamp":1767443003000},"page":"1348-1362","source":"Crossref","is-referenced-by-count":4,"title":["Sex differences in electrocardiograms of trained athletes: a systematic review and meta-analysis"],"prefix":"10.1093","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9327-901X","authenticated-orcid":false,"given":"Angus J","family":"Davis","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health, The University of Sydney , Sydney, NSW ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rheannon","family":"van der Linden","sequence":"additional","affiliation":[{"name":"Cardiovascular Program, The George Institute for Global Health , Sydney, NSW ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameera","family":"Mukhtar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, The University of Sydney , Sydney, NSW ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danica","family":"Sardelich","sequence":"additional","affiliation":[{"name":"The Sports Clinic @ The University of Sydney , Camperdown, NSW ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8455-8161","authenticated-orcid":false,"given":"Simone","family":"Ungaro","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova , Padua ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3578-0583","authenticated-orcid":false,"given":"Alessandro","family":"Zorzi","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova , Padua ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6603-2262","authenticated-orcid":false,"given":"Bradley J","family":"Petek","sequence":"additional","affiliation":[{"name":"Sports Cardiology Program, Knight Cardiovascular Institute, Oregon Health & Science University , Portland, OR ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tochukwu","family":"Ilodibia","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Army Command and NAOWA Hospital , Abuja ,","place":["Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4602-7535","authenticated-orcid":false,"given":"Ludmila","family":"Cosio-Lima","sequence":"additional","affiliation":[{"name":"Department of Movement Science and Health, University of West Florida , Pensacola, FL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Krol","sequence":"additional","affiliation":[{"name":"Department of Sports Cardiology and Noninvasive Cardiovascular Imaging, Medical University of Warsaw , Warsaw 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