Anterior T-Wave Inversion in Young White Athletes and Nonathletes: Prevalence and Significance

Aneil Malhotra; Harshil Dhutia; Sabiha Gati; Tee-Joo Yeo; Helder Dores; Rachel Bastiaenen; Rajay Narain; Ahmed Merghani; Gherardo Finocchiaro; Nabeel Sheikh; Alexandros Steriotis; Abbas Zaidi; Lynne Millar; Elijah Behr; Maite Tome; Michael Papadakis; Sanjay Sharma

doi:10.1016/j.jacc.2016.10.044

Anterior T-Wave Inversion in Young White Athletes and Nonathletes: Prevalence and Significance

Aneil Malhotra, Harshil Dhutia, Sabiha Gati, Tee-Joo Yeo, Helder Dores, Rachel Bastiaenen, Rajay Narain, Ahmed Merghani, Gherardo Finocchiaro, Nabeel Sheikh, Alexandros Steriotis, Abbas Zaidi, Lynne Millar, Elijah Behr, Maite Tome, Michael Papadakis, Sanjay Sharma

NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)

Research output: Contribution to journal › Article › peer-review

90 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	1-9
Number of pages	9
Journal	Journal of the American College of Cardiology
Volume	69
Issue number	1
DOIs	https://doi.org/10.1016/j.jacc.2016.10.044
Publication status	Published - 3 Jan 2017

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Journal Article

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10.1016/j.jacc.2016.10.044

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Malhotra, A., Dhutia, H., Gati, S., Yeo, T-J., Dores, H., Bastiaenen, R., Narain, R., Merghani, A., Finocchiaro, G., Sheikh, N., Steriotis, A., Zaidi, A., Millar, L., Behr, E., Tome, M., Papadakis, M., & Sharma, S. (2017). Anterior T-Wave Inversion in Young White Athletes and Nonathletes: Prevalence and Significance. Journal of the American College of Cardiology, 69(1), 1-9. https://doi.org/10.1016/j.jacc.2016.10.044

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title = "Anterior T-Wave Inversion in Young White Athletes and Nonathletes: Prevalence and Significance",

abstract = "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.",

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author = "Aneil Malhotra and Harshil Dhutia and Sabiha Gati and Tee-Joo Yeo and Helder Dores and Rachel Bastiaenen and Rajay Narain and Ahmed Merghani and Gherardo Finocchiaro and Nabeel Sheikh and Alexandros Steriotis and Abbas Zaidi and Lynne Millar and Elijah Behr and Maite Tome and Michael Papadakis and Sanjay Sharma",

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Malhotra, A, Dhutia, H, Gati, S, Yeo, T-J, Dores, H, Bastiaenen, R, Narain, R, Merghani, A, Finocchiaro, G, Sheikh, N, Steriotis, A, Zaidi, A, Millar, L, Behr, E, Tome, M, Papadakis, M & Sharma, S 2017, 'Anterior T-Wave Inversion in Young White Athletes and Nonathletes: Prevalence and Significance', Journal of the American College of Cardiology, vol. 69, no. 1, pp. 1-9. https://doi.org/10.1016/j.jacc.2016.10.044

TY - JOUR

T1 - Anterior T-Wave Inversion in Young White Athletes and Nonathletes

T2 - Prevalence and Significance

AU - Malhotra, Aneil

AU - Dhutia, Harshil

AU - Gati, Sabiha

AU - Yeo, Tee-Joo

AU - Dores, Helder

AU - Bastiaenen, Rachel

AU - Narain, Rajay

AU - Merghani, Ahmed

AU - Finocchiaro, Gherardo

AU - Sheikh, Nabeel

AU - Steriotis, Alexandros

AU - Zaidi, Abbas

AU - Millar, Lynne

AU - Behr, Elijah

AU - Tome, Maite

AU - Papadakis, Michael

AU - Sharma, Sanjay

PY - 2017/1/3

Y1 - 2017/1/3

N2 - 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.

AB - 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.

KW - Journal Article

U2 - 10.1016/j.jacc.2016.10.044

DO - 10.1016/j.jacc.2016.10.044

M3 - Article

C2 - 28057231

SN - 0735-1097

VL - 69

SP - 1

EP - 9

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 1

ER -

Anterior T-Wave Inversion in Young White Athletes and Nonathletes: Prevalence and Significance

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