Echocardiographic Findings in Peri-pubertal Athletes
Objective T wave inversion (TWI) has been associated with cardiomyopathies. The hypothesis of this study was that TWI has relevant clinical significance in peri-pubertal athletes.
Methods Consecutive male soccer players, aged 8–18 years, undergoing preparticipation screening between January 2008 and March 2009 were enrolled. Medical and family histories were collected; physical examinations, 12-lead ECGs and transthoracic echocardiogram (TTE) were performed. TWI was categorised by ECG lead (anterior (V1–V3), extended anterior (V1–V4), inferior (DII–aVF) and infero-lateral (DII–aVF/V4–V6/DI-aVL)) and by age.
Results Overall, 2261 (mean age 12.4 years, 100% Caucasian) athletes were enrolled. TWI in ≥2 consecutive ECG leads was found in 136 athletes (6.0%), mostly in anterior leads (126/136, 92.6%). TWI in anterior leads was associated with TTE abnormalities in 6/126 (4.8%) athletes. TWI in extended anterior (2/136, 1.5%) and inferior (3/136, 2.2%) leads was never associated with abnormal TTE. TWI in infero-lateral leads (5/136, 3.7%) was associated with significant TTE abnormalities (3/5, 60.0%), including one hypertrophic cardiomyopathy (HCM) and two LV hypertrophies. Athletes with normal T waves had TTE abnormalities in 4.4% of cases, including one HCM with deep Q waves in infero-lateral leads.
Conclusions In this broad population of peri-pubertal male athletes, TWI in anterior leads was associated with mild cardiac disease in 4.8% of cases, while TWI in infero-lateral leads revealed HCM and LV hypertrophy in 60% of cases. ECG identified all cases of HCM.
The prevalence and clinical significance of T wave inversion (TWI) at ECG in young athletes has been a subject of investigation. Previous studies have shown that TWI in leads V1–V2 are relatively rare among athletes, with a prevalence ranging from 2.5%, to 4.7%, and 0.8% when they extend to V3. TWI in infero-lateral leads has been described in 1.5%–1.8% of postpubertal Caucasian athletes, and inverted T waves confined to lateral leads were observed in 0.1%–0.3% of young athletes. Although independent from training-related physiological cardiac remodelling, in the absence of echocardiographic abnormalities and cardiac symptoms, TWI in anterior leads have traditionally been considered benign in children. Conversely, their persistence after puberty or their presence in inferior and lateral leads has been associated with cardiomyopathy.
The hypothesis of this study was that TWI has relevant clinical significance in peri-pubertal athletes. Therefore, a systematic application of transthoracic echocardiogram (TTE) during preparticipation screening was adopted in a selected population of peri-pubertal male athletes competing at the regional level, with or without TWI at ECG.
Abstract and Introduction
Abstract
Objective T wave inversion (TWI) has been associated with cardiomyopathies. The hypothesis of this study was that TWI has relevant clinical significance in peri-pubertal athletes.
Methods Consecutive male soccer players, aged 8–18 years, undergoing preparticipation screening between January 2008 and March 2009 were enrolled. Medical and family histories were collected; physical examinations, 12-lead ECGs and transthoracic echocardiogram (TTE) were performed. TWI was categorised by ECG lead (anterior (V1–V3), extended anterior (V1–V4), inferior (DII–aVF) and infero-lateral (DII–aVF/V4–V6/DI-aVL)) and by age.
Results Overall, 2261 (mean age 12.4 years, 100% Caucasian) athletes were enrolled. TWI in ≥2 consecutive ECG leads was found in 136 athletes (6.0%), mostly in anterior leads (126/136, 92.6%). TWI in anterior leads was associated with TTE abnormalities in 6/126 (4.8%) athletes. TWI in extended anterior (2/136, 1.5%) and inferior (3/136, 2.2%) leads was never associated with abnormal TTE. TWI in infero-lateral leads (5/136, 3.7%) was associated with significant TTE abnormalities (3/5, 60.0%), including one hypertrophic cardiomyopathy (HCM) and two LV hypertrophies. Athletes with normal T waves had TTE abnormalities in 4.4% of cases, including one HCM with deep Q waves in infero-lateral leads.
Conclusions In this broad population of peri-pubertal male athletes, TWI in anterior leads was associated with mild cardiac disease in 4.8% of cases, while TWI in infero-lateral leads revealed HCM and LV hypertrophy in 60% of cases. ECG identified all cases of HCM.
Introduction
The prevalence and clinical significance of T wave inversion (TWI) at ECG in young athletes has been a subject of investigation. Previous studies have shown that TWI in leads V1–V2 are relatively rare among athletes, with a prevalence ranging from 2.5%, to 4.7%, and 0.8% when they extend to V3. TWI in infero-lateral leads has been described in 1.5%–1.8% of postpubertal Caucasian athletes, and inverted T waves confined to lateral leads were observed in 0.1%–0.3% of young athletes. Although independent from training-related physiological cardiac remodelling, in the absence of echocardiographic abnormalities and cardiac symptoms, TWI in anterior leads have traditionally been considered benign in children. Conversely, their persistence after puberty or their presence in inferior and lateral leads has been associated with cardiomyopathy.
The hypothesis of this study was that TWI has relevant clinical significance in peri-pubertal athletes. Therefore, a systematic application of transthoracic echocardiogram (TTE) during preparticipation screening was adopted in a selected population of peri-pubertal male athletes competing at the regional level, with or without TWI at ECG.