title: Anterior T-Wave Inversion in Young White Athletes and Nonathletes: Prevalence and Significance.
abstract: BACKGROUND
  Anterior T-wave inversion (ATWI) on electrocardiography (ECG) in young white adults raises the possibility of cardiomyopathy, specifically arrhythmogenic right ventricular cardiomyopathy (ARVC). Whereas the 2010 European consensus recommendations for ECG interpretation in young athletes state that ATWI beyond lead V1warrants further investigation, the prevalence and significance of ATWI have never been reported in a large population of asymptomatic whites.
  
  
  OBJECTIVE
  This study investigated the prevalence and significance of ATWI in a large cohort of young, white adults including athletes.
  
  
  METHODS
  Individuals 16 to 35 years of age (n = 14,646), including 4,720 females (32%) and 2,958 athletes (20%), were evaluated by using a health questionnaire, physical examination, and 12-lead ECG. ATWI was defined as T-wave inversion in ≥2 contiguous anterior leads (V1to V4).
  
  
  RESULTS
  ATWI was detected in 338 individuals (2.3%) and was more common in women than in men (4.3% vs. 1.4%, respectively; p < 0.0001) and more common among athletes than in nonathletes (3.5% vs. 2.0%, respectively; p < 0.0001). T-wave inversion was predominantly confined to leads V1to V2(77%). Only 1.2% of women and 0.2% of men exhibited ATWI beyond V2. No one with ATWI fulfilled diagnostic criteria for ARVC after further evaluation. During a mean follow-up of 23.1 ± 12.2 months none of the individuals with ATWI experienced an adverse event.
  
  
  CONCLUSIONS
  ATWI confined to leads V1to V2is a normal variant or physiological phenomenon in asymptomatic white individuals without a relevant family history. ATWI beyond V2is rare, particularly in men, and may warrant investigation.
authors.affiliation: Division of Cardiovascular Sciences, St. George's University of London, United Kingdom.
authors.forename: Aneil
authors.initials: A
authors.lastname: Malhotra
authors.affiliation: Division of Cardiovascular Sciences, St. George's University of London, United Kingdom.
authors.forename: Harshil
authors.initials: H
authors.lastname: Dhutia
authors.affiliation: Division of Cardiovascular Sciences, St. George's University of London, United Kingdom.
authors.forename: Sabiha
authors.initials: S
authors.lastname: Gati
authors.affiliation: Division of Cardiovascular Sciences, St. George's University of London, United Kingdom.
authors.forename: Tee-Joo
authors.initials: TJ
authors.lastname: Yeo
authors.affiliation: Department of Cardiology, Universidade Nova de Lisboa, Hospital das Forças Armadas, Luz Saúde, NOVA Medical School, Lisbon, Portugal.
authors.forename: Helder
authors.initials: H
authors.lastname: Dores
authors.affiliation: Division of Cardiovascular Sciences, St. George's University of London, United Kingdom.
authors.forename: Rachel
authors.initials: R
authors.lastname: Bastiaenen
authors.affiliation: Division of Cardiovascular Sciences, St. George's University of London, United Kingdom.
authors.forename: Rajay
authors.initials: R
authors.lastname: Narain
authors.affiliation: Division of Cardiovascular Sciences, St. George's University of London, United Kingdom.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Merghani
authors.affiliation: Division of Cardiovascular Sciences, St. George's University of London, United Kingdom.
authors.forename: Gherardo
authors.initials: G
authors.lastname: Finocchiaro
authors.affiliation: Division of Cardiovascular Sciences, St. George's University of London, United Kingdom.
authors.forename: Nabeel
authors.initials: N
authors.lastname: Sheikh
authors.affiliation: Division of Cardiovascular Sciences, St. George's University of London, United Kingdom.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Steriotis
authors.affiliation: Division of Cardiovascular Sciences, St. George's University of London, United Kingdom.
authors.forename: Abbas
authors.initials: A
authors.lastname: Zaidi
authors.affiliation: Division of Cardiovascular Sciences, St. George's University of London, United Kingdom.
authors.forename: Lynne
authors.initials: L
authors.lastname: Millar
authors.affiliation: Division of Cardiovascular Sciences, St. George's University of London, United Kingdom.
authors.forename: Elijah
authors.initials: E
authors.lastname: Behr
authors.affiliation: Division of Cardiovascular Sciences, St. George's University of London, United Kingdom.
authors.forename: Maite
authors.initials: M
authors.lastname: Tome
authors.affiliation: Division of Cardiovascular Sciences, St. George's University of London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Papadakis
authors.affiliation: Division of Cardiovascular Sciences, St. George's University of London, United Kingdom. Electronic address: sasharma@sgul.ac.uk.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D056352:Athletes; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D003937:Diagnosis, Differential; D018618:Echocardiography, Doppler, Color; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D015995:Prevalence; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: ECG screening; anterior T-wave inversion; arrhythmogenic right ventricular cardiomyopathy; ethnicity