Abstract 15102: Are T wave Inversions in the Anterior Precordial Leads Benign in African- Americans?

Abstract

Introduction: While it has been proposed that T wave inversions (TWI) in the anterior precordial leads can be a normal finding in the ECGs of Afro-Caribbean athletes, it is uncertain whether this holds true for African-Americans. Hypothesis: TWI in the anterior precordial leads can be a non-specific marker of cardiac disease, and as a result, assuming a benign nature for TWI in the anterior leads in African-American athletes may not be appropriate

Methods: To begin to investigate this notion, we evaluated the incidence of cardiovascular death (CVD) in apparently healthy African- Americans with anterior TWI over an 11 year period. We analyzed the ECGs and CV deaths in 5334 ambulatory African Americans (average age 50 years, 8% female, average follow up of 8 years) seen at the Palo Alto VA Health Care system from 1986 until 1997. T waves were coded as inverted in V2, V3, V4 and V5 if TWI were noted to be more than 1 mm below the PR segment. The leads coded as inverted were summed to create a score from 0 to 4.

Results: Those with a score from 1 to 3 (20% of the sample) had a similar increased risk relative to those without TWI (79.5%), while those with TWI in 4 leads or greater (score 4, 0.5% of the sample) had the greatest mortality. Age and gender adjusted Cox Hazard analysis demonstrated a hazard of 2.5X (CI 2-6) for scores of 1 to 3 and a hazard of 5X (CI 2-9) for a score of 4 (i.e., V2345).

Conclusions: Though our findings are based on an older clinical population, they suggest that assuming a benign nature for TWI in the anterior leads in African-American athletes may not be appropriate. At this time, we do not believe there is sufficient evidence to clear African-American athletes with TWI in any of the anterior precordial leads for sports participation without further work up.