The Recognition and Significance of Pathological T-Wave Inversions in Athletes
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 athlete's state that PTWI (except in leads aVR, III and V1 and in V1-V4 when preceeded by domed ST segment in asymptomatic Afro-Caribbean athletes only) cannot be considered a physiological adapation. The aims of the study were to prospectively determine the prevalence of cardiac pathology in athletes presenting with PTWI, and to examine the efficacy of cardiac magnetic resonance (CMR) in the work-up battery of further examinations.
Methods and Results—55 athletes presenting with PTWI were investigated with clinical examination, ECG, echocardiography, exercise testing, 24h Holter ECG and CMR. 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, whilst CMR 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 SCD and ST-segment depression associated with PTWI were predictive of cardiac disease.
Conclusions—PTWI should be considered pathological in all cases until proven otherwise, as it was associated with cardiac pathology in 45% of athletes. Despite echocardiography identifying pathology in half of these cases, CMR must be considered routine in athletes presenting with PTWI with normal echocardiography. Whilst exclusion from competitive sport is not warranted in the presence of normal secondary examinations, annual follow-up is essential to ascertain possible disease expression.
- Received May 12, 2014.
- Revision received October 2, 2014.
- Accepted October 10, 2014.