Recognition and significance of pathological T-wave inversions in athletes

Frédéric Schnell, Nathan R. Riding, Rory O'Hanlon, Pierre Axel Lentz, Erwan Donal, Gaelle Kervio, David Matelot, Guillaume Leurent, Stéphane Doutreleau, Laurent Chevalier, Sylvain Guerard, Mathew G. Wilson, François Carré

Research output: Contribution to journalArticle

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Abstract

Background-Pathological T-wave inversion (PTWI) is rarely observed on the ECG of healthy athletes, whereas it is common in patients with certain cardiac diseases. All ECG interpretation guidelines for use within athletes state that PTWI (except in leads aVR, III and V1 and in V1-V4 when preceded by domed ST segment in asymptomatic Afro-Caribbean athletes only) cannot be considered a physiological adaptation. The aims of the present study were to prospectively determine the prevalence of cardiac pathology in athletes presenting with PTWI, and to examine the efficacy of cardiac magnetic resonance in the work-up battery of further examinations. Methods and Results-Athletes presenting with PTWI (n=155) were investigated with clinical examination, ECG, echocardiography, exercise testing, 24h Holter ECG, and cardiac magnetic resonance. Cardiac disease was established in 44.5% of athletes, with hypertrophic cardiomyopathy (81%) the most common pathology. Echocardiography was abnormal in 53.6% of positive cases, and cardiac magnetic resonance identified a further 24 athletes with disease. Five athletes (7.2%) considered normal on initial presentation subsequently expressed pathology during follow-up. Familial history of sudden cardiac death and ST-segment depression associated with PTWI were predictive of cardiac disease. Conclusions-PTWI should be considered pathological in all cases until proven otherwise, because it was associated with cardiac pathology in 45% of athletes. Despite echocardiography identifying pathology in half of these cases, cardiac magnetic resonance must be considered routine in athletes presenting with PTWI with normal echocardiography. Although exclusion from competitive sport is not warranted in the presence of normal secondary examinations, annual follow-up is essential to ascertain possible disease expression.

Original languageEnglish
Pages (from-to)165-173
Number of pages9
JournalCirculation
Volume131
Issue number2
DOIs
Publication statusPublished - 2014
Externally publishedYes

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Athletes
Echocardiography
Pathology
Electrocardiography
Magnetic Resonance Spectroscopy
Heart Diseases
Physiological Adaptation
Hypertrophic Cardiomyopathy
Sudden Cardiac Death
Sports
Guidelines
Exercise

Cite this

Schnell, F., Riding, N. R., O'Hanlon, R., Lentz, P. A., Donal, E., Kervio, G., ... Carré, F. (2014). Recognition and significance of pathological T-wave inversions in athletes. Circulation, 131(2), 165-173. https://doi.org/10.1161/CIRCULATIONAHA.114.011038
Schnell, Frédéric ; Riding, Nathan R. ; O'Hanlon, Rory ; Lentz, Pierre Axel ; Donal, Erwan ; Kervio, Gaelle ; Matelot, David ; Leurent, Guillaume ; Doutreleau, Stéphane ; Chevalier, Laurent ; Guerard, Sylvain ; Wilson, Mathew G. ; Carré, François. / Recognition and significance of pathological T-wave inversions in athletes. In: Circulation. 2014 ; Vol. 131, No. 2. pp. 165-173.
@article{3732515183064d24b13c99ae67931a77,
title = "Recognition and significance of pathological T-wave inversions in athletes",
abstract = "Background-Pathological T-wave inversion (PTWI) is rarely observed on the ECG of healthy athletes, whereas it is common in patients with certain cardiac diseases. All ECG interpretation guidelines for use within athletes state that PTWI (except in leads aVR, III and V1 and in V1-V4 when preceded by domed ST segment in asymptomatic Afro-Caribbean athletes only) cannot be considered a physiological adaptation. The aims of the present study were to prospectively determine the prevalence of cardiac pathology in athletes presenting with PTWI, and to examine the efficacy of cardiac magnetic resonance in the work-up battery of further examinations. Methods and Results-Athletes presenting with PTWI (n=155) were investigated with clinical examination, ECG, echocardiography, exercise testing, 24h Holter ECG, and cardiac magnetic resonance. Cardiac disease was established in 44.5{\%} of athletes, with hypertrophic cardiomyopathy (81{\%}) the most common pathology. Echocardiography was abnormal in 53.6{\%} of positive cases, and cardiac magnetic resonance identified a further 24 athletes with disease. Five athletes (7.2{\%}) considered normal on initial presentation subsequently expressed pathology during follow-up. Familial history of sudden cardiac death and ST-segment depression associated with PTWI were predictive of cardiac disease. Conclusions-PTWI should be considered pathological in all cases until proven otherwise, because it was associated with cardiac pathology in 45{\%} of athletes. Despite echocardiography identifying pathology in half of these cases, cardiac magnetic resonance must be considered routine in athletes presenting with PTWI with normal echocardiography. Although exclusion from competitive sport is not warranted in the presence of normal secondary examinations, annual follow-up is essential to ascertain possible disease expression.",
keywords = "Arrhythmogenic right ventricular cardiomyopathy, Athletes, Cardiomyopathy, Hypertrophic",
author = "Fr{\'e}d{\'e}ric Schnell and Riding, {Nathan R.} and Rory O'Hanlon and Lentz, {Pierre Axel} and Erwan Donal and Gaelle Kervio and David Matelot and Guillaume Leurent and St{\'e}phane Doutreleau and Laurent Chevalier and Sylvain Guerard and Wilson, {Mathew G.} and Fran{\cc}ois Carr{\'e}",
year = "2014",
doi = "10.1161/CIRCULATIONAHA.114.011038",
language = "English",
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pages = "165--173",
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Schnell, F, Riding, NR, O'Hanlon, R, Lentz, PA, Donal, E, Kervio, G, Matelot, D, Leurent, G, Doutreleau, S, Chevalier, L, Guerard, S, Wilson, MG & Carré, F 2014, 'Recognition and significance of pathological T-wave inversions in athletes', Circulation, vol. 131, no. 2, pp. 165-173. https://doi.org/10.1161/CIRCULATIONAHA.114.011038

Recognition and significance of pathological T-wave inversions in athletes. / Schnell, Frédéric; Riding, Nathan R.; O'Hanlon, Rory; Lentz, Pierre Axel; Donal, Erwan; Kervio, Gaelle; Matelot, David; Leurent, Guillaume; Doutreleau, Stéphane; Chevalier, Laurent; Guerard, Sylvain; Wilson, Mathew G.; Carré, François.

In: Circulation, Vol. 131, No. 2, 2014, p. 165-173.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Recognition and significance of pathological T-wave inversions in athletes

AU - Schnell, Frédéric

AU - Riding, Nathan R.

AU - O'Hanlon, Rory

AU - Lentz, Pierre Axel

AU - Donal, Erwan

AU - Kervio, Gaelle

AU - Matelot, David

AU - Leurent, Guillaume

AU - Doutreleau, Stéphane

AU - Chevalier, Laurent

AU - Guerard, Sylvain

AU - Wilson, Mathew G.

AU - Carré, François

PY - 2014

Y1 - 2014

N2 - Background-Pathological T-wave inversion (PTWI) is rarely observed on the ECG of healthy athletes, whereas it is common in patients with certain cardiac diseases. All ECG interpretation guidelines for use within athletes state that PTWI (except in leads aVR, III and V1 and in V1-V4 when preceded by domed ST segment in asymptomatic Afro-Caribbean athletes only) cannot be considered a physiological adaptation. The aims of the present study were to prospectively determine the prevalence of cardiac pathology in athletes presenting with PTWI, and to examine the efficacy of cardiac magnetic resonance in the work-up battery of further examinations. Methods and Results-Athletes presenting with PTWI (n=155) were investigated with clinical examination, ECG, echocardiography, exercise testing, 24h Holter ECG, and cardiac magnetic resonance. Cardiac disease was established in 44.5% of athletes, with hypertrophic cardiomyopathy (81%) the most common pathology. Echocardiography was abnormal in 53.6% of positive cases, and cardiac magnetic resonance identified a further 24 athletes with disease. Five athletes (7.2%) considered normal on initial presentation subsequently expressed pathology during follow-up. Familial history of sudden cardiac death and ST-segment depression associated with PTWI were predictive of cardiac disease. Conclusions-PTWI should be considered pathological in all cases until proven otherwise, because it was associated with cardiac pathology in 45% of athletes. Despite echocardiography identifying pathology in half of these cases, cardiac magnetic resonance must be considered routine in athletes presenting with PTWI with normal echocardiography. Although exclusion from competitive sport is not warranted in the presence of normal secondary examinations, annual follow-up is essential to ascertain possible disease expression.

AB - Background-Pathological T-wave inversion (PTWI) is rarely observed on the ECG of healthy athletes, whereas it is common in patients with certain cardiac diseases. All ECG interpretation guidelines for use within athletes state that PTWI (except in leads aVR, III and V1 and in V1-V4 when preceded by domed ST segment in asymptomatic Afro-Caribbean athletes only) cannot be considered a physiological adaptation. The aims of the present study were to prospectively determine the prevalence of cardiac pathology in athletes presenting with PTWI, and to examine the efficacy of cardiac magnetic resonance in the work-up battery of further examinations. Methods and Results-Athletes presenting with PTWI (n=155) were investigated with clinical examination, ECG, echocardiography, exercise testing, 24h Holter ECG, and cardiac magnetic resonance. Cardiac disease was established in 44.5% of athletes, with hypertrophic cardiomyopathy (81%) the most common pathology. Echocardiography was abnormal in 53.6% of positive cases, and cardiac magnetic resonance identified a further 24 athletes with disease. Five athletes (7.2%) considered normal on initial presentation subsequently expressed pathology during follow-up. Familial history of sudden cardiac death and ST-segment depression associated with PTWI were predictive of cardiac disease. Conclusions-PTWI should be considered pathological in all cases until proven otherwise, because it was associated with cardiac pathology in 45% of athletes. Despite echocardiography identifying pathology in half of these cases, cardiac magnetic resonance must be considered routine in athletes presenting with PTWI with normal echocardiography. Although exclusion from competitive sport is not warranted in the presence of normal secondary examinations, annual follow-up is essential to ascertain possible disease expression.

KW - Arrhythmogenic right ventricular cardiomyopathy

KW - Athletes

KW - Cardiomyopathy

KW - Hypertrophic

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U2 - 10.1161/CIRCULATIONAHA.114.011038

DO - 10.1161/CIRCULATIONAHA.114.011038

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JO - Circulation (Baltimore)

JF - Circulation (Baltimore)

SN - 0009-7322

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Schnell F, Riding NR, O'Hanlon R, Lentz PA, Donal E, Kervio G et al. Recognition and significance of pathological T-wave inversions in athletes. Circulation. 2014;131(2):165-173. https://doi.org/10.1161/CIRCULATIONAHA.114.011038