Abstract 1619: Prevalence And Clinical Significance Of Right Precordial T-wave Inversion At Electrocardiographic Preparticipation Screening: A Prospective Study On 3086 Young Competitive Athletes
Background: T-wave inversion in right precordial leads (beyond V1) is usually dismissed in young people as non-specific or as persistence of the juvenile T-wave pattern. However, such a pattern is an important ECG marker of arrhythmogenic right ventricular cardiomyopathy (ARVC), a recognized leading cause of sudden death during sports. We prospectively assessed the prevalence and clinical significance of T-wave abnormality in right precordial leads in a large consecutive series of young competitive athletes.
Methods: We examined the basal 12-lead ECG of 3086 consecutive young competitive athletes (2138 maschi, 948 femmine, age range 7–35 years, mean 15.4±9 years) who underwent preparticipation screening at the Center for Sports Medicine in Padova (Northeast Italy), focusing on repolarization abnormalities in right precordial leads. The prevalence of T-wave abnormality was correlated with age, gender, type of sports, pubertal development (according to Tanner’s tables), anthropometric characteristic and training level. Athletes with ECG abnormalities were further evaluated by echocardiography.
Results: One hundred-twenty seven athletes (4.1%) showed T-wave inversion beyond V1: 70 (2.3%) in leads V1 and V2 and 57 (1.8%) in leads V1 to V3 or beyond. The prevalence of right precordial T-wave inversion decreased significantly with increasing age (1.4% in athletes aged ≥14 years vs 9,3% in those aged <14 years; p<0.001), body surface area (p<0.001) and body mass index (p<0.001); moreover, it was significantly lower in individuals with complete vs incomplete pubertal development (1.3% vs 10.5%; p<0.001). There was no statistically significant association between right precordial T-wave inversion and gender, type of sports, and level of athletic training. Among the 127 athletes who underwent ecocardiographic study because of right precordial T-wave inversion, 3 (2.3%) were diagnosed with ARVC and disqualified from competitive sports activity, accounting for an estimated disease prevalence of 0.1% in the general young athletic population.
Conclusion: T-wave inversion in right precordial leads is an uncommon ECG finding in post-pubertal athletes and deserves accurate investigation because may reflect an underlying ARVC.