Prevalence of Cardiomyopathy in Italian Asymptomatic Children With Electrocardiographic T-Wave Inversion at Preparticipation Screening

Abstract

Background-T-wave inversion on a 12-lead ECG is usually dismissed in young people as normal persistence of the juvenile pattern of repolarization. However, T-wave inversion is a common ECG abnormality of cardiomyopathies such as hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy, which are leading causes of sudden cardiac death in athletes. We prospectively assessed the prevalence, age relation, and underlying cardiomyopathy of T-wave inversion in children undergoing preparticipation screening. Methods and Results-The study population included 2765 consecutive Italian children (1914 male participants; mean age, 13.9Ϯ2.2 years; range 8 -18 years) undergoing preparticipation screening including an ECG. Of 229 children (8%) who underwent further evaluation because of positive findings at initial preparticipation screening, 33 (1.2%) were diagnosed with cardiovascular disease. T-wave inversion was recorded in 158 children (5.7%) and was localized in the right precordial leads in 131 (4.7%). The prevalence of right precordial T-wave inversion decreased significantly with increasing age (8.4% in children Ͻ14 years of age versus 1.7% in those Ն14 years; PϽ0.001), pubertal development (9.5% of children with incomplete versus 1.6% with complete development; PϽ0.001), and body mass index below the 10th percentile (PϽ0.001). Incomplete pubertal development was the only independent predictor for right precordial T-wave inversion (odds ratio, 3.6; 95% confidence interval, 1.9 -6.8; PϽ0.001). Of 158 children with T-wave inversion, 4 (2.5%) had a diagnosis of cardiomyopathy, including arrhythmogenic right ventricular cardiomyopathy (nϭ3) and hypertrophic cardiomyopathy (nϭ1). Conclusions-The prevalence of T-wave inversion decreases significantly after puberty. Echocardiographic investigation of children with postpubertal persistence of T-wave inversion at preparticipation screening is warranted because it may lead to presymptomatic diagnosis of a cardiomyopathy that could lead to sudden cardiac death during sports. (Circulation. 2012;125:529-538.)

Prevalence and Prognostic Significance of T-Wave Inversions in Right Precordial Leads of a 12-Lead Electrocardiogram in the Middle-Aged Subjects

“…12 In another study of asymptomatic children with T-wave inversion at preparticipation screening, diagnosis of cardiomyopathy was made in only 2.5% of the subjects with abnormal ECG. 22 In the present study, the overall prevalence of inverted right precordial T waves was 0.5% in this 30-to 59-year-old population. This is somewhat lower than what is reported in some previous studies, probably because of exclusion of the youngest age groups, in which juvenile inverted T waves are more prevalent.…”

Meta-analysis on risk stratification of malignant ventricular tachyarrhythmic events in arrhythmogenic right ventricular cardiomyopathy

“…In our meta-analysis, a significant association was observed between late potentials and occurrence of tachyarrhythmias in the patients with ARVC. The presence of T-wave inversion in V1-V3 or premature ventricular complexes of the left bundle branch block morphology on 12-lead electrocardiography could also be the first alarming signs of right ventricular change [25]; however, their values in identifying patients at risk of ventricular tachyarrhythmias/ICD therapy were not significant in our subgroup analysis.…”

Arrhythmogenic Right Ventricular Cardiomyopathy

“…The presence of T-wave inversion in V 1 -V 3 or premature ventricular complexes of left bundle branch block morphology on 12-lead ECG could be also the first alarming signs during a cardiological check-up. 39 Less common presentation is congestive heart failure that may mimic dilated cardiomyopathy. In a prospective study of consecutive patients with suspected ARVC, evaluated by a standard protocol including biopsy, a surprisingly high incidence (15%) of cardiac sarcoid was found.…”