Significance of deep T-wave inversions in asymptomatic athletes with normal cardiovascular examinations

Practical solutions for managing the diagnostic conundrum

M. G. Wilson, S. Sharma, F. Carré, P. Charron, P. Richard, R. O'Hanlon, S. K. Prasad, H. Heidbuchel, J. Brugada, O. Salah, M. Sheppard, K. P. George, G. Whyte, B. Hamilton, H. Chalabi

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Preparticipation screening programmes for underlying cardiac pathologies are now commonplace for many international sporting organisations. However, providing medical clearance for an asymptomatic athlete without a family history of sudden cardiac death (SCD) is especially challenging when the athlete demonstrates particularly abnormal repolarisation patterns, highly suggestive of an inherited cardiomyopathy or channelopathy. Deep T-wave inversions of .2 contiguous anterior or lateral leads (but not aVR, and III) are of major concern for sports cardiologists who advise referring team physicians, as these ECG alterations are a recognised manifestation of hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC). Subsequently, inverted T-waves may represent the fi rst and only sign of an inherited heart muscle disease, in the absence of any other features and before structural changes in the heart can be detected. However, to date, there remains little evidence that deep T-wave inversions are always pathognomonic of either a cardiomyopathy or an ion channel disorder in an asymptomatic athlete following long-term follow-up. This paper aims to provide a systematic review of the prevalence of T-wave inversion in athletes and examine T-wave inversion and its relationship to structural heart disease, notably HCM and ARVC with a view to identify young athletes at risk of SCD during sport. Finally, the review proposes clinical management pathways (including genetic testing) for asymptomatic athletes demonstrating signifi cant T-wave inversion with structurally normal hearts.

Original languageEnglish
Pages (from-to)i51-i57
Number of pages9
JournalBritish Journal of Sports Medicine
Volume46
Issue numberSUPPL. 1
DOIs
Publication statusPublished - Nov 2012
Externally publishedYes

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Athletes
Arrhythmogenic Right Ventricular Dysplasia
Hypertrophic Cardiomyopathy
Sudden Cardiac Death
Cardiomyopathies
Sports
Heart Diseases
Channelopathies
Critical Pathways
Genetic Testing
Ion Channels
Myocardium
Electrocardiography
Organizations
Pathology
Physicians

Cite this

Wilson, M. G. ; Sharma, S. ; Carré, F. ; Charron, P. ; Richard, P. ; O'Hanlon, R. ; Prasad, S. K. ; Heidbuchel, H. ; Brugada, J. ; Salah, O. ; Sheppard, M. ; George, K. P. ; Whyte, G. ; Hamilton, B. ; Chalabi, H. / Significance of deep T-wave inversions in asymptomatic athletes with normal cardiovascular examinations : Practical solutions for managing the diagnostic conundrum. In: British Journal of Sports Medicine. 2012 ; Vol. 46, No. SUPPL. 1. pp. i51-i57.
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Wilson, MG, Sharma, S, Carré, F, Charron, P, Richard, P, O'Hanlon, R, Prasad, SK, Heidbuchel, H, Brugada, J, Salah, O, Sheppard, M, George, KP, Whyte, G, Hamilton, B & Chalabi, H 2012, 'Significance of deep T-wave inversions in asymptomatic athletes with normal cardiovascular examinations: Practical solutions for managing the diagnostic conundrum', British Journal of Sports Medicine, vol. 46, no. SUPPL. 1, pp. i51-i57. https://doi.org/10.1136/bjsports-2012-090838

Significance of deep T-wave inversions in asymptomatic athletes with normal cardiovascular examinations : Practical solutions for managing the diagnostic conundrum. / Wilson, M. G.; Sharma, S.; Carré, F.; Charron, P.; Richard, P.; O'Hanlon, R.; Prasad, S. K.; Heidbuchel, H.; Brugada, J.; Salah, O.; Sheppard, M.; George, K. P.; Whyte, G.; Hamilton, B.; Chalabi, H.

In: British Journal of Sports Medicine, Vol. 46, No. SUPPL. 1, 11.2012, p. i51-i57.

Research output: Contribution to journalArticle

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T1 - Significance of deep T-wave inversions in asymptomatic athletes with normal cardiovascular examinations

T2 - Practical solutions for managing the diagnostic conundrum

AU - Wilson, M. G.

AU - Sharma, S.

AU - Carré, F.

AU - Charron, P.

AU - Richard, P.

AU - O'Hanlon, R.

AU - Prasad, S. K.

AU - Heidbuchel, H.

AU - Brugada, J.

AU - Salah, O.

AU - Sheppard, M.

AU - George, K. P.

AU - Whyte, G.

AU - Hamilton, B.

AU - Chalabi, H.

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