244: Significance of T-wave inversions in athletes

BackgroundT-wave inversion beyond V1 is rarely observed on the ECG of healthy athletes (< 4%), whereas it is a common finding in patients with cardiomyopathy. Thus recent ESC recommendations for interpretation of resting ECG in the athlete underlined that this ECG pattern is not due to physical training and request cardiovascular exams. Classical exam performed is resting echocardiography. In this prospective study the respective value of different non invasive exams performed in case of negative T waves in athletes was evaluated.MethodWe prospectively included 49 athletes with T-wave inversion beyond V1. They underwent intensive cardiac investigations (exercise test, 24h ECG Holter monitor, rest and exercise echocardiography, cardiac MRI) to identify a potential cause.ResultsIn all cases ECG was realized for pre-participation screening. Only few subjects reported cardiovascular symptoms (n=10) or cardiac murmur (n=5). Thus in most cases no evidence of cardiovascular disease (n=34) was noted. In 25 subjects no significant abnormality was detected. Cardiomyopathy was diagnosed in 24 (49%) subjects, 20 HCM, 1 ARVC and 3 resolutives myocarditis. In the cardiac disease group, only 4 presented cardiovascular symptoms vs 6 in the non pathologic one (n=25). In 2 patients with myocarditis but normal echocardiography, the diagnosis was performed by cardiac MRI because of evidence of late gadolinium enhancement (LGE). LGE was also useful for risk stratification in HCM patients (8). Exercise echocardiography was very useful in 2 patients for the diagnosis of HCM by unmasking dynamic LVOT obstruction, and in 1 patient with myocarditis by showing absence of contractile reserve.ConclusionT-wave inversions in athletes cannot be regarded as a physiological adaptation even in absence of symptoms. An intensive cardiac evaluation is necessary including cardiac MRI and exercise echocardiography in subjects with considered normal resting echocardiography and exercise ECG