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Background: T-wave inversion on a 12-lead ECG is usually dismissed in young people as normal persistence of the juvenile pattern of repolarization. However, T-wave inversion is a common ECG abnormality of cardiomyopathies such as hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy, which are leading causes of sudden cardiac death in athletes. We prospectively assessed the prevalence, age relation, and underlying cardiomyopathy of T-wave inversion in children undergoing preparticipation screening., Methods and Results: The study population included 2765 consecutive Italian children (1914 male participants; mean age, 13.9±2.2 years; range 8-18 years) undergoing preparticipation screening including an ECG. Of 229 children (8%) who underwent further evaluation because of positive findings at initial preparticipation screening, 33 (1.2%) were diagnosed with 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 of age versus 1.7% in those ≥14 years; P<0.001), pubertal development (9.5% of children with incomplete versus 1.6% with complete development; P<0.001), and body mass index below the 10th percentile (P<0.001). Incomplete pubertal development was the only independent predictor for right precordial T-wave inversion (odds ratio, 3.6; 95% confidence interval, 1.9-6.8; P<0.001). Of 158 children with T-wave inversion, 4 (2.5%) had a diagnosis of cardiomyopathy, including arrhythmogenic right ventricular cardiomyopathy (n=3) and hypertrophic cardiomyopathy (n=1)., Conclusions: The prevalence of T-wave inversion decreases significantly after puberty. Echocardiographic investigation of children with postpubertal persistence of T-wave inversion at preparticipation screening is warranted because it may lead to presymptomatic diagnosis of a cardiomyopathy that could lead to sudden cardiac death during sports.

Background: The association between mitral valve prolapse (MVP) and cryptogenic stroke is controversial. The Atrial Septal Aneurysm Multicenter Italian (ASA-MI) Study is a prospective multicenter study evaluating the prevalence of atrial septal aneurysm (ASA) in patients with a recent stroke and normal carotid arteries. The aim of the present research was to evaluate the frequency of ASA and its association with MVP in the stroke population and in the subgroup of young patients (< 55 years) included in the ASA-MI Study., Methods: The study group included 245 of the 606 patients referred for transesophageal echocardiography (168 men and 77 women, mean age 65.7 +/- 21 years). All patients were selected on the basis of a recent episode of unexplained cerebral ischemia and were included in the study if they had normal carotid arteries. The control population included 245 patients (mean age 64.7 +/- 23 years) who underwent transesophageal echocardiographic evaluation during the same period for indications other than cerebral ischemia. The subgroup of young patients (< 55 years) included 90 patients (61 men and 29 women, mean age 49 +/- 5 years)., Results: The prevalence of MVP was 18% (95% confidence interval 8 to 21%) in the stroke population and 15% (95% confidence interval 7 to 20%) in the control population (chi 2 = 2.1, p = NS). The prevalence of MVP did not differ between young stroke patients (28.8%) and young controls (20%) (chi 2 = 0.835, p = 0.3). MVP was not significantly associated with stroke. We found an association between ASA and MVP: there was a higher incidence of MVP in stroke patients with an ASA than in patients without stroke or an ASA (40.9 vs 25%, p < 0.05). There was also a higher frequency of MVP associated with ASA in the group of young patients than in all patients of the ASA-MI Study (28.8 vs 18%, chi 2 = 20.313, p < 0.001)., Conclusions: We found an association between ASA and MVP in patients with recent stroke and this association bore a higher risk of cerebral events than in patients without these abnormalities.

The paper reports an electrocardiographic and M and B-mode echocardiographical study in 3682 non-selected patients among which a total of 241 were identified with mitral valve prolapse. In males the highest frequency was found during the second decade of life with a tendency to decrease with increasing age. In females, who were found to be the most severely affected (2:1 in relation to males), two peaks of incidence were observed during the third and fifth decade, with a greater frequency in the latter and a marked absence of cases in the fourth decade. Many echocardiographically diagnosed mitral prolapses were both clinically and electrocardiographically silent; moreover it was observed that the risks of this complication increased in parallel to the thinness and redundance of the mitralic flap affected by prolapse and the dilation of the valvular ring.

The results of many studies on the prevalence of mitral valve prolapse have been greatly influenced by the diagnostic methods and criteria adopted as well as by population selection. The method of choice today is 2d-echocardiography because of its ability to highlight both movement anomaly (i.e. functional prolapse) and any eventual morphological variations of the mitral valve (i.e. anatomic prolapse). The latter (chordae lengthening, thickening and overabundance of the leaflets, dilation of the valvular ring) are, nowadays, considered especially important even as predictive factors of complications. Therefore we studied the prevalence of these two types of prolapse in a population of 420 university students. Functional mitral valve prolapse was found in 27/420 (6.4%) and anatomical prolapse in 2 cases (0.5%). No auscultatory finding was present in 24/27 patients with functional prolapse. There was no correlation between the two types of mitral valve prolapse and the body mass index, the fractional shortening of the left ventricle and symptoms (dyspnea, palpitations, precordial pain, dizziness). We think that the distinction between the two types of mitral valve prolapse should prove very useful for the comparison of results in future epidemiological studies. Follow-up of both groups of patients will hopefully clarify the usefulness of such distinction from the clinical point of view.

The Authors have developed an epidemiologic screening among 299 subjects girl's secondary school (average 16.5 years) to verify the incidence of idiopathic mitral valve prolapse (MVP) and associated thoracic-skeletal abnormalities in young female people. The MVP was assessed in 10 subjects (3.3%), scoliosis in 41 subjects (13.7%). The MVP incidence among scoliotic subjects was 19.5% (8 among 41). To verify a possible common systemic connective tissue disorder between scoliosis and MVP, three groups of subjects (control, scoliosis, MVP), were visited by orthopedist, considering the incidence of following clinic parameters: recurvated knee, flat or valgus foot, pectus excavatum, lofty scapulas, joint and skin laxity. A significative increasing incidence of these parameters was found from the control group to the MVP group. Considering these parameters as index of a probable systemic connective tissue disorder, the hypothesis of a mesenchimal etiopathogenesis of MVP is confirmed.