Echocardiographic findings in 2261 peri-pubertal athletes with or without inverted T waves at electrocardiogram.
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.
Division of Cardiology, Policlinico Casilino, ASL Rome B, Rome, Italy.
Leonardo
L
Calò
Division of Cardiology, Policlinico Casilino, ASL Rome B, Rome, Italy Department of Health Sciences, University of Rome "Foro Italico", Rome, Italy.
Fabio
F
Sperandii
Division of Cardiology, Policlinico Casilino, ASL Rome B, Rome, Italy.
Annamaria
A
Martino
Division of Cardiology, Policlinico Casilino, ASL Rome B, Rome, Italy Department of Health Sciences, University of Rome "Foro Italico", Rome, Italy.
Emanuele
E
Guerra
The FMSI Sport Medicine Institute, Villa Stuart Sport Clinic-FIFA Centre of Excellence, Rome, Italy Department of Medical-Surgical Sciences and Biotechnologies, University of Rome "La Sapienza", Rome, Italy.
Elena
E
Cavarretta
Department of Health Sciences, University of Rome "Foro Italico", Rome, Italy.
Federico
F
Quaranta
Division of Cardiology, Policlinico Casilino, ASL Rome B, Rome, Italy.
Ermenegildo de
Ed
Ruvo
Division of Cardiology, Policlinico Casilino, ASL Rome B, Rome, Italy.
Luigi
L
Sciarra
Department of Health Sciences, University of Rome "Foro Italico", Rome, Italy.
Attilio
A
Parisi
The FMSI Sport Medicine Institute, Villa Stuart Sport Clinic-FIFA Centre of Excellence, Rome, Italy.
Antonia
A
Nigro
Institute of Sports Medicine and Science (CONI), Rome, Italy.
Antonio
A
Spataro
Department of Health Sciences, University of Rome "Foro Italico", Rome, Italy.
Fabio
F
Pigozzi
D000293:Adolescent; D056352:Athletes; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D002648:Child; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D011627:Puberty; D012189:Retrospective Studies
MYOCARDIAL DISEASE