Prevalence and significance of T-wave inversion in children practicing sport: A prospective, 4-year follow-up study

D’Ascenzi, Flavio; Anselmi, Francesca; Berti, Beatrice; Capitani, Elena; Chiti, Chiara; Franchini, A; Graziano, Francesca; Nistri, Stefano; Focardi, Marta; Capitani, Massimo; Corrado, Domenico; Bonifazi, Marco; Mondillo, Sergio

doi:10.1016/j.ijcard.2018.09.069

Cited by 21 publications

(8 citation statements)

References 19 publications

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“…30 A recent longitudinal study on 2227 children, pre-pubertal and younger in comparison with the previous cited studies (mean age 12.3 ± 2.0 years) practicing sport, demonstrates a high prevalence of TWI, up to 16%. 9 This longitudinal study confirmed that anterior TWI become positive in the vast majority of the children (94%) after a 4-year follow-up, with only 6% of children still exhibiting anterior TWI, in absence of family history, symptoms or relevant clinical findings. In this population, anterior TWI becomes positive by the age of 14 years in most of the children.…”

Section: Inferior Twisupporting

confidence: 72%

“…Conversely, TWI in the infero-lateral leads was rare (only 3% of children), persists after puberty and was also associated with structural heart disease in one case. 9 In conclusion, an accurate differentiation between pathological and physiological ECG patterns is crucial in children with TWI, frequently presenting dynamic changes in the anterior leads, related to age and development. In this age group (such as in adults), TWI in the inferolateral leads should undergo further investigations to identify potential cardiomyopathies.…”

Section: Inferior Twimentioning

confidence: 97%

“…7 The prevalence of lateral TWI in athletes varies between 0.3% and 1.5% 21,22 and it seems to be 10 times higher in black than white athletes. 23 The presence of lateral and inferolateral TWI is associated with the existence of a cardiomyopathy in a large number of athletes 2,9,11,22,24 (see Figure 2). Accordingly, these patterns of TWI should always raise the suspicion of an underlining heart disease and should prompt a comprehensive investigation in order to exclude a life-threatening cardiac condition.…”

Section: Anterior Twimentioning

confidence: 99%

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Interpretation of T‐wave inversion in physiological and pathological conditions: Current state and future perspectives

D’Ascenzi

Anselmi

Adami

et al. 2020

Clinical Cardiology

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The presence of T-wave inversion (TWI) at 12-lead electrocardiogram (ECG) in competitive athletes is one of the major diagnostic challenges for sports physicians and consulting cardiologists. Indeed, while the presence of TWI may be associated with some benign conditions and it may be occasionally seen in healthy athletes presenting signs of cardiac remodeling, it may also represent an early sign of an underlying, concealed structural heart disease or life-threatening arrhythmogenic cardiomyopathies, which may be responsible for exercise-related sudden cardiac death (SCD). The interpretation of TWI in athletes is complex and the inherent implications for the clinical practice represent a conundrum for physicians. Accordingly, the detection of TWI should be viewed as a potential red flag on the ECG of young and apparently healthy athletes and warrants further investigations because it may represent the initial expression of cardiomyopathies that may not be evident until many years later and that may ultimately be associated with adverse outcomes. The aim of this review is, therefore, to report an update of the literature on TWI in athletes, with a specific focus on the interpretation and management.

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Section: Inferior Twisupporting

confidence: 72%

Section: Inferior Twimentioning

confidence: 97%

Section: Anterior Twimentioning

confidence: 99%

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Interpretation of T‐wave inversion in physiological and pathological conditions: Current state and future perspectives

D’Ascenzi

Anselmi

Adami

et al. 2020

Clinical Cardiology

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“…8 , N O . 3 , 2 0 2 2patients before the age of 14 years(3,14,15). Ageappropriate criteria were used to assess late potentials on signal-averaged ECG recordings, as published previously (16).…”

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confidence: 99%

Clinical Characteristics and Follow-Up of Pediatric-Onset Arrhythmogenic Right Ventricular Cardiomyopathy

Roudijk

Verheul

Bosman

et al. 2022

JACC: Clinical Electrophysiology

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“…This chronological cut‐off is a practical simplification of the fact that prepubertal children commonly show anterior TWI in V1‐V3, the so‐called “benign juvenile repolarization pattern”. However, studies on peripubertal athletes highlighted that normalization of the juvenile repolarization pattern depends on the biological rather than chronological age 37‐39 …”

Section: Areas Of Uncertaintymentioning

confidence: 99%

Criteria for interpretation of the athlete's ECG: A critical appraisal

Zorzi

Vio

Bettella

et al. 2020

Pacing Clinical Electrophis

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The electrocardiogram (ECG) is cheap and widely available but its use as a screening tool for early identification of athletes with a cardiac disease at risk of sudden cardiac death is controversial because of presumed low specificity. In the last decade, several efforts have been made to improve the distinction between physiological and pathological ECG findings in the athlete, leading to continuous evolution of the interpretation criteria. The most recent 2017 International criteria grouped ECG changes into three categories: normal, borderline, and abnormal. Borderline findings warrant further investigations only when two or more are present while abnormal changes should always be considered as the sign of a possible underlying disease. This review encompasses the evolution of the athlete's ECG interpretation criteria and highlights areas of uncertainty that will need to be addressed by further studies.

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Prevalence and significance of T-wave inversion in children practicing sport: A prospective, 4-year follow-up study

Cited by 21 publications

References 19 publications

Interpretation of T‐wave inversion in physiological and pathological conditions: Current state and future perspectives

Interpretation of T‐wave inversion in physiological and pathological conditions: Current state and future perspectives

Clinical Characteristics and Follow-Up of Pediatric-Onset Arrhythmogenic Right Ventricular Cardiomyopathy

Criteria for interpretation of the athlete's ECG: A critical appraisal

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