Article Text

103 Prevalence And Significance Of Anterior T Wave Inversion In Females
  1. Aneil Malhotra,
  2. Harshil Dhutia,
  3. Sabiha Gati,
  4. Helder Dores,
  5. Lynne Millar,
  6. Rajay Merghani,
  7. Ahmed Merghani,
  8. Michael Walker,
  9. Michael Papadakis,
  10. Sanjay Sharma
  1. St. George’s University of London


Purpose Anterior T wave inversion (V1-V4) is the hallmark of arrhythmogenic right ventricular cardiomyopathy (ARVC). However, it is widely perceived that anterior T wave inversion is also common in female individuals. Previous studies in small cohorts of female athletes have demonstrated a highly variable prevalence of anterior T wave inversion of up to 14%. This study investigated the prevalence and significance of anterior T wave inversion in a large, unselected cohort of female athletic and non-athletic individuals who underwent cardiac screening.

Methods Between May 2007 and September 2013, 17,708 individuals (n = 5,234; 29.6% females) aged 14–35 underwent cardiac screening with health questionnaire, 12-lead ECG and consultation with a cardiologist. Further evaluation was dictated by initial results. The ECGs of female subjects were analysed placing emphasis on the presence of anterior T wave inversion, defined as T wave inversion in ≥2 contiguous anterior leads.

Results T wave inversion was present in 322 (6.2%) females, the majority confined to the anterior leads; 73% anterior, 14% lateral, 13% inferior. Anterior T wave inversion was more prevalent in competitive athletes compared to non-athletes (7.02 vs 3.78%, p < 0.001) and in black females compared to white females (14.62 vs 4.21%, p < 0.001). Anterior T-wave inversions persisted in 5.29% of females >16 years of age. The majority of anterior T wave inversion (n = 171; 73%) was confined to leads V1-V2, with only 1.2% of females exhibiting T wave inversion beyond V2, raising the suspicion of ARVC. Multivariate analysis identified black ethnicity as the sole, independent predictor for the presence of anterior T wave inversion (OR 3.1, 95% CI 1.2–8.4, p = 0.03).

Conclusion In the largest unselected cohort of females to date, the overall prevalence of anterior T wave inversion was higher (4.5%) than those in previously reported studies. This was also the case for females of Caucasian ethnicity. Anterior T wave inversion persisted in a considerable proportion of females >16 years, excluding the ‘juvenile’ pattern. Although we did not identify ARVC in any females with anterior T wave inversion, given the low prevalence of T wave inversion beyond V2, particularly in Caucasian individuals (1.06%), such patterns not be considered a normal finding and should trigger further clinical evaluation.

  • T wave inversion
  • arrhythmogenic right ventricular cardiomyopathy
  • screening

Statistics from

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.