Author + information
- Received July 13, 2016
- Revision received October 1, 2016
- Accepted October 11, 2016
- Published online January 2, 2017.
- Aneil Malhotra, MBBChir, MA, MSca,
- Harshil Dhutia, MBBS, BSca,
- Sabiha Gati, MBBS, PhDa,
- Tee-Joo Yeo, MDa,
- Helder Dores, MDb,
- Rachel Bastiaenen, MBBS, PhDa,
- Rajay Narain, MBBSa,
- Ahmed Merghani, MBBS, BMedScia,
- Gherardo Finocchiaro, MDa,
- Nabeel Sheikh, MBBS, BSca,
- Alexandros Steriotis, MD, PhDa,
- Abbas Zaidi, MBBS, MD, BSc, MDa,
- Lynne Millar, MBBS, BSca,
- Elijah Behr, MBBS, MDa,
- Maite Tome, MD, PhDa,
- Michael Papadakis, MBBS, MDa and
- Sanjay Sharma, MBBS, BSc, MDa,∗ ()
- aDivision of Cardiovascular Sciences, St. George’s University of London, United Kingdom
- bDepartment of Cardiology, Universidade Nova de Lisboa, Hospital das Forças Armadas, Luz Saúde, NOVA Medical School, Lisbon, Portugal
- ↵∗Reprint requests and correspondence:
Professor Sanjay Sharma, St. George’s University of London, Cranmer Terrace, London SW17 0RE, United Kingdom.
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 V1 warrants further investigation, the prevalence and significance of ATWI have never been reported in a large population of asymptomatic whites.
Objectives 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 (V1 to 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 V1 to 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 V1 to V2 is a normal variant or physiological phenomenon in asymptomatic white individuals without a relevant family history. ATWI beyond V2 is rare, particularly in men, and may warrant investigation.
Drs. Malhotra, Dhutia, Yeo, Steriotis, Finocchiaro, Narain, and Millar were supported by a research grant from the charitable organization Cardiac Risk in the Young. Dr. Merghani was supported by the British Heart Foundation. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 13, 2016.
- Revision received October 1, 2016.
- Accepted October 11, 2016.
- American College of Cardiology Foundation