Frédéric Schnell1, Nathan Riding1, Rory O'Hanlon1, Pierre Axel Lentz1, Erwan Donal1, Gaelle Kervio1, David Matelot1, Guillaume Leurent1, Stéphane Doutreleau1, Laurent Chevalier1, Sylvain Guerard1, Mathew G Wilson1, François Carré2. 1. From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes France (P.A.L.); the Department of Cardiology, Pontchaillou Hospital, Rennes France (E.D., G.L.); the Department of Physiology, Nouvel Hopital Civil, Strasbourg, France (S.D.); Clinique du Sport Bordeaux-Mérignac, France (L.C.); and the Department of Cardiology, Desgenettes Hospital, Lyon, France (S.G.). 2. From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes France (P.A.L.); the Department of Cardiology, Pontchaillou Hospital, Rennes France (E.D., G.L.); the Department of Physiology, Nouvel Hopital Civil, Strasbourg, France (S.D.); Clinique du Sport Bordeaux-Mérignac, France (L.C.); and the Department of Cardiology, Desgenettes Hospital, Lyon, France (S.G.). francois.carre@univ-rennes1.fr.
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.
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.
Authors: Cameron H Landry; Katherine S Allan; Kim A Connelly; Kris Cunningham; Laurie J Morrison; Paul Dorian Journal: N Engl J Med Date: 2017-11-16 Impact factor: 91.245
Authors: Daniele Massera; Robyn L McClelland; Bharath Ambale-Venkatesh; Antoinette S Gomes; W Gregory Hundley; Nadine Kawel-Boehm; Kihei Yoneyama; David S Owens; Mario J Garcia; Mark V Sherrid; Jorge R Kizer; Joao A C Lima; David A Bluemke Journal: J Am Heart Assoc Date: 2019-04-16 Impact factor: 5.501