Recognition and Significance of Pathological T-Wave Inversions in Athletes

Abstract

Background— Pathological T-wave inversion (PTWI) is rarely observed on the ECG of healthy athletes, whereas it is common in patients with certain cardiac diseases. All ECG interpretation guidelines for use within athletes state that PTWI (except in leads aVR, III and V1 and in V1–V4 when preceded by domed ST segment in asymptomatic Afro-Caribbean athletes only) cannot be considered a physiological adaptation. The aims of the present study were to prospectively determine the prevalence of cardiac pathology in athletes presenting with PTWI, and to examine the efficacy of cardiac magnetic resonance in the work-up battery of further examinations. Methods and Results— Athletes presenting with PTWI (n=155) were investigated with clinical examination, ECG, echocardiography, exercise testing, 24h Holter ECG, and cardiac magnetic resonance. Cardiac disease was established in 44.5% of athletes, with hypertrophic cardiomyopathy (81%) the most common pathology. Echocardiography was abnormal in 53.6% of positive cases, and cardiac magnetic resonance identified a further 24 athletes with disease. Five athletes (7.2%) considered normal on initial presentation subsequently expressed pathology during follow-up. Familial history of sudden cardiac death and ST-segment depression associated with PTWI were predictive of cardiac disease. Conclusions— PTWI should be considered pathological in all cases until proven otherwise, because it was associated with cardiac pathology in 45% of athletes. Despite echocardiography identifying pathology in half of these cases, cardiac magnetic resonance must be considered routine in athletes presenting with PTWI with normal echocardiography. Although exclusion from competitive sport is not warranted in the presence of normal secondary examinations, annual follow-up is essential to ascertain possible disease expression.

Clinical Profile of Athletes With Hypertrophic Cardiomyopathy

“…Contrary to a previous publication, 18 25% of athletes with HCM achieved a pVO 2 >120% of predicted. In line with a recent publication, 30 the value of CMRI is underscored by the …”

The U-shaped relationship between exercise and cardiac morbidity

“…29 TWI was mainly confined to the lateral leads with 80% exhibiting concomitant ST segment depression laterally. The significance of inferior TWI confined to the inferior leads is unknown; however, longitudinal follow-up studies have revealed an association between lateral TWI and sudden death or a subsequent diagnosis of HCM.…”

Prevalence and significance of isolated T wave inversion in 1755 consecutive American collegiate athletes

“…Previous studies have evaluated the prevalence and significance of TWI. Many of these studies, however, included TWI in association with other abnormalities such as ST depression and abnormal Q waves [7]. The purpose of this study was to evaluate the prevalence of isolated T-wave inversion in American collegiate athletes and investigate ethnic and gender disparities using the most contemporary criteria.…”