Prevalence and significance of T-wave inversion in children practicing sport: A prospective, 4-year follow-up study. (15th March 2019)

• Record Type: Journal Article
• Authors: D'Ascenzi, Flavio; Anselmi, Francesca; Berti, Beatrice; Capitani, Elena; Chiti, Chiara; Franchini, Andrea; Graziano, Francesca; Nistri, Stefano; Focardi, Marta; Capitani, Massimo; Corrado, Domenico; Bonifazi, Marco; Mondillo, Sergio
• Is Part Of: International journal of cardiology. Volume 279(2019)
• Page Start: 100
• Page End: 104
• Publication Date: 2019-03-15
• Subjects: Electrocardiography -- Negative T waves -- Cardiomyopathy -- Pre-participation screening -- Athlete's heart; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.09.069
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: T-wave inversion (TWI) is rare in athlete's heart but is a common manifestation in cardiomyopathies. Although TWI has been extensively investigated in adult athletes, the ability of this ECG pattern to distinguish between a physiological variant and a developing heart muscle disease in children is controversial. The aim of this longitudinal study was to establish the prevalence, changes and clinical significance of TWI in a large cohort of pre-adolescent athletes. Methods: 2227 children (mean age 12.3 ± 2.0 years) undergoing sports preparticipation screening were included. Children with TWI underwent yearly follow-up until the positivisation of TWI for a maximum follow-up of 4 years. Results: Among 2227 children, 358 (16%) had TWI. Children with TWI were younger (11.4 ± 2.1 vs. 12.5 ± 2.0 years, p < 0.0001) and had a lower BSA than children without TWI ( p < 0.0001). 97% of children showed anterior TWI while only 3% had infero-lateral TWI. Anterior TWI became positive in 94% of children during the 4-year follow-up ( p < 0.0001 vs. baseline) and the remaining 6% did not show abnormal clinical findings. Conversely, in the group of 9 children with infero-lateral TWI, only 1 showed normalisation during follow-up ( p = 0.81) and 1 was found to have a cardiomyopathy. Conclusions: Anterior TWI is common in children and generally becomes positive by the age of 14 years. Conversely, infero-lateral TWI is rare, persistent and may be associated with structural heart disease. Therefore, infero-lateral TWI should not be interpreted as physiologically related to age, development or training and children with infero-lateral TWI should remain under strict clinical surveillance. Highlights: This study establishes the prevalence of TWI in a large cohort of children practising sport This longitudinal study demonstrates that anterior TWI usually becomes positive by the age of 14 years Conversely, children with infero-lateral TWI followed for 4 years did not demonstrate significant changes in the ECG pattern Infero-lateral TWI should not be interpreted as physiologically related to age, development or training This study support the concept that children with infero-lateral TWI should remain under strict clinical surveillance