1. Significance of deep T-wave inversions in asymptomatic athletes with normal cardiovascular examinations: practical solutions for managing the diagnostic conundrum
- Author
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Hein Heidbuchel, B. Hamilton, Philippe Charron, Patrick Richard, F. Carré, Josep Brugada, Mathew G Wilson, Hakim Chalabi, Mary N. Sheppard, Greg Whyte, Sanjay Sharma, Rory O'Hanlon, S. K. Prasad, Othman Salah, Keith George, Department of Sports Medicine, Qatar Orthopaedic and Sports Medicine Hospital-ASPETAR, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Cardiovascular Sciences - Arrhythmology, Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven)-University Hospital Gasthuisberg, Cardiology Department, University of Barcelona, Pathology Department, Imperial College London-Royal Brompton Hospital and Imperial College London, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven)-University Hospital Gasthuisberg [Leuven], and Imperial College London
- Subjects
Heart disease ,Cardiomyopathy ,030204 cardiovascular system & hematology ,MESH: Risk Assessment ,Sudden cardiac death ,Electrocardiography ,0302 clinical medicine ,MESH: Early Diagnosis ,Pathognomonic ,Medicine ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,MESH: Critical Pathways ,MESH: Athletes ,Arrhythmogenic Right Ventricular Dysplasia ,MESH: Genetic Testing ,Hypertrophic cardiomyopathy ,New Directions ,General Medicine ,Prognosis ,MESH: Cardiomyopathy, Hypertrophic ,Arrhythmogenic right ventricular dysplasia ,Critical Pathways ,Cardiology ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,medicine.symptom ,Sports ,medicine.medical_specialty ,Physical Therapy, Sports Therapy and Rehabilitation ,Risk Assessment ,Asymptomatic ,MESH: Prognosis ,Right ventricular cardiomyopathy ,MESH: Physical Examination ,03 medical and health sciences ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Internal medicine ,Humans ,Genetic Testing ,Physical Examination ,MESH: Arrhythmogenic Right Ventricular Dysplasia ,MESH: Humans ,business.industry ,MESH: Death, Sudden, Cardiac ,Cardiomyopathy, Hypertrophic ,medicine.disease ,MESH: Electrocardiography ,Death, Sudden, Cardiac ,Early Diagnosis ,Athletes ,MESH: Sports ,business - Abstract
International audience; Preparticipation screening programmes for underlying cardiac pathologies are now commonplace for many international sporting organisations. However, providing medical clearance for an asymptomatic athlete without a family history of sudden cardiac death (SCD) is especially challenging when the athlete demonstrates particularly abnormal repolarisation patterns, highly suggestive of an inherited cardiomyopathy or channelopathy. Deep T-wave inversions of ≥ 2 contiguous anterior or lateral leads (but not aVR, and III) are of major concern for sports cardiologists who advise referring team physicians, as these ECG alterations are a recognised manifestation of hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC). Subsequently, inverted T-waves may represent the first and only sign of an inherited heart muscle disease, in the absence of any other features and before structural changes in the heart can be detected. However, to date, there remains little evidence that deep T-wave inversions are always pathognomonic of either a cardiomyopathy or an ion channel disorder in an asymptomatic athlete following long-term follow-up. This paper aims to provide a systematic review of the prevalence of T-wave inversion in athletes and examine T-wave inversion and its relationship to structural heart disease, notably HCM and ARVC with a view to identify young athletes at risk of SCD during sport. Finally, the review proposes clinical management pathways (including genetic testing) for asymptomatic athletes demonstrating significant T-wave inversion with structurally normal hearts.
- Published
- 2012