T-wave inversion on 12-lead electrocardiogram (ECG) is usually dismissed in young people as normal persistence of the juvenile pattern of repolarisation. However, T-wave inversion is a common ECG abnormality of cardiomyopathies (CMPs), such as hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC), which are leading causes of sudden cardiac death (SCD) in athletes. We prospectively assessed the prevalence, age-relation and underlying CMP of T-wave inversion in children undergoing pre-participation screening (PPS).Methods and Results -
The study population included 2,765 consecutive children (1,914 males; mean age 13.9±2.2 years; range 8-18 years) undergoing PPS including ECG. Of 229 (8%) children who underwent further evaluation because of positive findings at initial PPS, 33 (1.2%) were diagnosed with a cardiovascular disease. T-wave inversion was recorded in 158 children (5.7%) and was localized in the right precordial leads in 131 (4.7%). The prevalence of right precordial T-wave inversion decreased significantly with increasing age (8.4% in children <14 years vs 1.7% ≥14 years;P<0.001), pubertal development (9.5% of children with incomplete vs 1.6% with complete development;P<0.001) and body mass index <10th percentile (P<0.001). Incomplete pubertal development was the only independent predictor for right precordial T-wave inversion (OR 3.6; 95%CI 1.9-6.8;P<0.001). Of 158 children with T-wave inversion, 4 (2.5%) had a diagnosis of CMP, including ARVC (n=3) and HCM (n=1).Conclusions -
The prevalence of T-wave inversion decreases significantly after puberty. Echocardiographic investigation of children with post-pubertal persistence of T-wave inversion at PPS is warranted because it may lead to pre-symptomatic diagnosis of a CMP at risk of SCD during sports.