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

Flavio D'Ascenzi,Antonio Pelliccia,Francesca Anselmi,Paolo Emilio Adami

doi:10.1002/clc.23365

Flavio D'Ascenzi, Antonio Pelliccia + Show 2 more

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https://doi.org/10.1002/clc.23365

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Abstract

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.

Highlights

T-wave inversion (TWI) is defined as negative T-wave of ≥1 mm in depth in two or more contiguous leads, with exclusion of leads aVR, III, and V1.1 The presence of TWI at 12-lead electrocardiogram (ECG) in competitive athletes is one of the major diagnostic challenges for sports physicians and consulting cardiologists.The interpretation of TWI in athletes is complex and the inherent implications for the clinical practice represent a conundrum for physicians
TWI may be occasionally seen in healthy athletes presenting signs of cardiac remodeling, such as left ventricular (LV) hypertrophy, atrial dilation, increase in ventricular cavity size, which may occasionally overlap with those of life-threatening arrhythmogenic cardiomyopathies
The identification of TWI should be viewed as a red flag on the ECG of young and apparently healthy athletes and warrants further investigations, having in mind that it may represent the initial expression of cardiomyopathies that may not be evident until many years later and that may be associated with adverse outcomes.[2]

Summary

Introduction

T-wave inversion (TWI) is defined as negative T-wave of ≥1 mm in depth in two or more contiguous leads, with exclusion of leads aVR, III, and V1.1 The presence of TWI at 12-lead electrocardiogram (ECG) in competitive athletes is one of the major diagnostic challenges for sports physicians and consulting cardiologists.The interpretation of TWI in athletes is complex and the inherent implications for the clinical practice represent a conundrum for physicians.

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