Abstract 9375: Role of Cardiac MRI in the Evaluation of T Wave Inversion in a Large Pre-Participation Cohort of Young Asian Males

Abstract

Introduction: Abnormal T wave inversion (ATWI) in the pre-participation screening (PPS) electrocardiogram (ECG) may signify underlying myocardial disorders (e.g. cardiomyopathy, myocarditis) associated with sudden cardiac death. Current guidelines for competitive athletes recommend evaluation of ATWI with transthoracic echocardiography (TTE) and follow-on cardiac magnetic resonance imaging (CMR) if TTE is normal (i.e. echo-negative). However, data on evaluation of ATWI detected on PPS outside of competitive athletes (e.g. recreational athletes or military enlistees) is lacking. Methods: We studied the yield of ATWI evaluation in a large unselected cohort of 48115 young Asian male military enlistees who underwent PPS between 2019-2021. Individuals with ATWI meeting the International Criteria 2017 definition underwent TTE. Echo-negative individuals with persistent ATWI on repeat ECG further underwent CMR and were followed up for 12 ± 8 months. Routine demographic, anthropometric and ECG parameters were collected. Individuals with known heart disease or conduction abnormalities (e.g. RBBB) were excluded. Results: 133 (0.3%) individuals had ATWI, amongst whom TTE detected 3 (2.3%) individuals with cardiomyopathy. 105 echo-negative individuals had persistent ATWI and underwent CMR, which detected a further 5 (4.8%) cases of cardiomyopathy and 2 (1.9%) cases of prior myocarditis with residual scar. Echo-negative individuals with myocardial disorders on CMR had deeper ATWI of ≥ 2mm (p=0.047), ATWI in lateral (p=0.046) or all 3 territories (p=0.006), and concomitant ST segment depressions (p=0.030). ATWI depth of < 2mm demonstrated 100% negative predictive value for myocardial disorders on TTE or CMR. Conclusions: Evaluation of ATWI in our unselected cohort of young Asian males identified myocardial disorders in 7.5%, with follow-on CMR increasing the diagnostic yield by 3-fold compared to TTE alone. Our findings confirm that CMR has utility in the evaluation of ATWI detected by PPS even in unselected individuals outside the competitive athletic setting. ATWI depth of ≥2mm was present in all individuals with myocardial disorders, and may serve as a cut-off value for further CMR evaluation in settings with resource limitations.