European Heart Journal Advance Access originally published online on May 9, 2009
European Heart Journal 2009 30(14):1728-1735; doi:10.1093/eurheartj/ehp164
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Prevalence and significance of T-wave inversions in predominantly Caucasian adolescent athletes
1 King's College Hospital, Denmark Hill, Denmark Hill, London SE5 9RS, UK
2 University Hospital Lewisham, Lewisham High Street, London, UK
3 Harefield Hospital, Hill End Road, London, UK
4 St George's Hospital, Blackshaw Road, London, UK
Received 19 September 2008; revised 21 March 2009; accepted 24 March 2009; online publish-ahead-of-print 9 May 2009.
* Corresponding author. Tel: +44 20 32 00 4475, Fax: +44 20 32 99 3489, Email: ssharma21{at}hotmail.com
Aims: Athletic activity is associated with electrocardiographic T-wave inversions in some adults, resembling those observed in cardiomyopathy. The prevalence and significance of T-wave inversions in adolescent athletes, the group most vulnerable to exercise-related sudden death from cardiomyopathy, is unknown.
Methods and results: This study evaluated 1710 adolescent athletes and 400 healthy controls. Subjects with T-wave inversions underwent intensive cardiac investigations to identify a potential cause. There was no significant difference in the overall prevalence of T-wave inversions between athletes and controls (4 vs. 3%; P = 0.46). T-wave inversions in leads V1–V3 were largely confined to athletes and controls aged <16 years. Only 0.1% of athletes aged 
16 years exhibited T-wave inversions beyond V2. T-wave inversions in the inferior and/or lateral leads and deep T-wave inversions occurred infrequently in athletes (1.5 and 0.8%, respectively) and were associated with a high prevalence of left ventricular hypertrophy or congenital cardiac anomalies. Despite intensive investigations, no athlete was diagnosed with a cardiomyopathy.
Conclusions: T-wave inversions in V1–V3 are relatively common in athletes <16 years and probably represent the juvenile electrocardiogram pattern. In adolescent athletes, T-wave inversions beyond V2 if 16 years, T-wave inversions in the inferior/lateral leads and deep T-wave inversions in any lead are unusual, warranting further investigations for underlying cardiomyopathy.
Key Words: Athelete's heart • Adolescent • Electrocardiography • T-wave inversion • Pre-participation