The electrocardiogram (ECG) is a non-invasive and cost-effective screening tool that is widely available and has been incorporated into many pre-participation screening programs for athletes. Despite historical criticisms regarding its suboptimal specificity, which could impact cost-effectiveness, the ECG remains a fundamental diagnostic method. Over the last 2 decades, significant research has focused on distinguishing pathological from physiological ECG patterns, the latter associated with the "athlete’s heart". The most recent guidelines for ECG interpretation in athletes include the International Criteria, published in 2017, which categorize ECG findings into common (training related), uncommon (training unrelated), and a "borderline" sub-group, with findings that do not necessitate further investigation when isolated. Premature ventricular beats (PVBs), although often overlooked, are a frequent cause of secondary investigations in athletes, especially when detected during exercise testing. Recent advances over the past decade have refined diagnostic methodologies, placing greater emphasis on morphological features, exercise relationships, and reproducibility, rather than solely on the count of PVBs. This evolution aims to enhance stratification for further investigations, such as cardiac magnetic resonance, which is crucial within this updated diagnostic framework, as it identifies pathologies causing sudden cardiac death during exercise. This review aims to provide a modern revision of the interpretation of ECGs and PVBs, incorporating a historical excursus to trace the evolution of these criteria. It is designed to offer clinicians a practical key for enhanced diagnostic precision in athlete screenings, reflecting both past insights and current advances.

The electrocardiogram (ECG) is a non-invasive and cost-effective screening tool that is widely available and has been incorporated into many pre-participation screening programs for athletes. Despite historical criticisms regarding its suboptimal specificity, which could impact cost-effectiveness, the ECG remains a fundamental diagnostic method. Over the last 2 decades, significant research has focused on distinguishing pathological from physiological ECG patterns, the latter associated with the "athlete’s heart". The most recent guidelines for ECG interpretation in athletes include the International Criteria, published in 2017, which categorize ECG findings into common (training related), uncommon (training unrelated), and a "borderline" sub-group, with findings that do not necessitate further investigation when isolated. Premature ventricular beats (PVBs), although often overlooked, are a frequent cause of secondary investigations in athletes, especially when detected during exercise testing. Recent advances over the past decade have refined diagnostic methodologies, placing greater emphasis on morphological features, exercise relationships, and reproducibility, rather than solely on the count of PVBs. This evolution aims to enhance stratification for further investigations, such as cardiac magnetic resonance, which is crucial within this updated diagnostic framework, as it identifies pathologies causing sudden cardiac death during exercise. This review aims to provide a modern revision of the interpretation of ECGs and PVBs, incorporating a historical excursus to trace the evolution of these criteria. It is designed to offer clinicians a practical key for enhanced diagnostic precision in athlete screenings, reflecting both past insights and current advances.

Lymphocyte subpopulations producing cytokines and exerting regulatory functions represent key immune elements. Given their reciprocal interdependency lymphocyte subpopulations are usually assayed as diagnostic panels, rather than single biomarkers for specialist clinical use. This retrospective analysis on lymphocyte subpopulations, analyzed over the last few years in an outpatient laboratory in Northeast Italy, contributes to the establishment of reference values for several regulatory lymphocytes currently lacking such reference ranges for the general population. Mean values and ranges in a sample of Caucasian patients (mean age 42±8,5 years), were provided for Th1, Th2, Th17, Th-reg, Tc-reg, Tc-CD57⁺ and B1 lymphocytes. The results are consistent with what is found in literature for the single subtypes and are: Th1 157.8±60.3/µl (7.3%±2.9); Th2 118.2±52.2/µl (5.4%±2.5); Th17 221.6±90.2/µl (10.5%±4.4); Th-reg 15.1±10.2/µl (0.7%±0.4); Tc-reg 5.8±4.7/µl (0.3%±0.2); Tc-CD57+ 103.7±114.1/µl (4.6%±4.7); B1 33.7±22.8/µl (1.5%±0.9); (Values are mean±SD). The results show that despite their variability, mean values are rather consistent in all age or sex groups and can be used as laboratory internal reference for this regulatory panel. Adding regulatory cells to lymphocyte subpopulations panels allows a more complete view of the state of the subject's immune network balance, thus improving the personalization and the “actionability” of diagnostic data in a systems medicine perspective.
Biomarkers ; Cytokines ; Humans ; Italy ; Lymphocyte Subsets* ; Lymphocytes* ; Outpatients ; Precision Medicine ; Reference Values* ; Retrospective Studies ; Specialization ; Systems Analysis