Isolated Anterior T-Wave Inversion in Elite Athletes: Prevalence and Clinical Relevance by Sex and Sporting Discipline.

Abstract

Background: Cardiac screening of elite athletes is common internationally. Female athletes are reported to have a higher proportion of abnormal screening ECGs compared with male athletes, despite lower rates of sudden cardiac death. T-wave inversion in leads V₂ and V₃ (TWI_V2-3) is considered abnormal for athletes aged ≥16 years, but there are knowledge gaps in prevalence and clinical outcomes.

Methods: Data were obtained from the ARENA (Australasian Registry of ECGs of National Athletes) project and combined with previous athlete cohort studies from Australia and New Zealand. Sporting disciplines included Olympic sports (summer and winter), Australian football, cricket, football (soccer), and netball. Logistic regression calculated adjusted odds ratios with 95% CIs for the odds of isolated TWI_V2-3 adjusting for sex and sporting discipline.

Results: Of 4423 athletes (40% female athletes; mean age, 19.7±4.5 years), isolated TWI_V2-3 was found in 36 athletes aged ≥16 years (27 [1.5%] female athletes, 9 [0.3%] male athletes). Isolated TWI_V2-3 was more common in female athletes compared with male athletes (adjusted odds ratio, 4.2 [95% CI, 2.0-9.5]) and endurance compared with nonendurance athletes (adjusted odds ratio, 4.8 [95% CI, 2.5-9.5]). Follow-up investigations were available in 34 of 36, including echocardiogram (n=30), magnetic resonance imaging (n=3), stress ECG (n=2), or subsequent normal ECG (n=13). After 6.4±2.6 years of follow-up, no athletes with isolated TWI_V2-3 were diagnosed with cardiac disease. Overall, female athletes had a higher proportion of abnormal ECGs compared with male athletes (4.2% versus 2.6%, P=0.004). If TWI_V2-3 was considered a normal finding in female athletes, female and male athletes would have similar proportions of abnormal ECGs (2.6% versus 2.6%, P=0.95).

Conclusions: Isolated TWI_V2-3 was 4 times more common in female athletes and 5 times more common in endurance athletes. This finding was not associated with cardiac pathology.