Peri-Pubertal Athlete T-Wave Inversion | Journal Scan

Study Questions:

Does T-wave inversion have clinical significance in peri-pubertal athletes?


Consecutive male soccer players ages 8-18 years undergoing preparticipation screening between January 2008 and March 2009 were studied. Medical and family histories were collected; physical examinations, 12-lead electrocardiograms (ECGs), and transthoracic echocardiograms (TTEs) were performed. T-wave inversion was categorized by ECG lead (anterior [V1 - V3], extended anterior [V1 - V4], inferior [II - aVF] and inferolateral [II - aVF/V4 - V6/I – aVL]), and by age.


Overall, 2,261 athletes (mean age 12.4 years, 100% Caucasian) were enrolled. T-wave inversion in ≥2 consecutive ECG leads was found in 136 athletes (6.0%), mostly in anterior leads (126/136, 92.6%). T-wave inversion in anterior leads was associated with TTE abnormalities in 6/126 (4.8%) athletes. T-wave inversion in extended anterior (2/136, 1.5%) and inferior (3/136, 2.2%) leads was never associated with TTE abnormalities. T-wave inversion in inferolateral leads (5/136, 3.7%) was associated with significant TTE abnormalities (3/5, 60.0%), including one patient with hypertrophic cardiomyopathy (HCM) and two with left ventricular (LV) hypertrophy; 4.4% of athletes with normal T waves had TTE abnormalities, including one patient with HCM who had deep Q waves in inferolateral leads.


In this broad population of peri-pubertal male athletes, T-wave inversion in the anterior ECG leads was associated with mild cardiac disease in 4.8% of cases, whereas T-wave inversion in the inferolateral leads revealed HCM and LV hypertrophy in 60% of cases. An ECG identified all patients with HCM.


This study of white peri-pubertal athletes in Rome, Italy, found that T-wave inversion was associated with cardiac abnormalities on echo, but only 1 of 93 abnormalities was HCM; other abnormalities were of sometimes-questionable clinical significance, or might have been detected otherwise (including mild LV dilation, atrial septal defect, atrial septal aneurysm, patent foramen ovale, bicuspid aortic valve, mitral valve prolapse, and patent ductus arteriosus). The study is of interest, but two caveats should be considered. First, ECG findings are race-dependent, and these findings might not be extrapolated safely to other populations. Second, the rationale to screen young athletes for diseases that pose no risk during athletics begs the question of whether screening should be used in all children––or in none.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Sports and Exercise Cardiology, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, Echocardiography/Ultrasound, Sports and Exercise and Congenital Heart Disease and Pediatric Cardiology, Sports and Exercise and Imaging

Keywords: Arrhythmias, Cardiac, Athletes, Electrocardiography, Echocardiography, Cardiomyopathy, Hypertrophic, Child, Heart Conduction System, Hypertrophy, Physical Examination

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