Introduction Anterior T wave inversion (ATWI) on an electrocardiogram (ECG) of an adult white individual raises the possibility of an underlying cardiomyopathy. While European consensus guidelines recommend that ATWI beyond V1 warrants further investigation, the prevalence and significance of ATWI has never been reported in a large white asymptomatic population.

Objective This study investigated the prevalence and significance of ATWI in a large cohort of young, white adults including athletes. This was an observational study with a mean follow-up period of 18.1 months.

Setting Several UK elite sporting organizations conduct ECG based pre-participation screening of athletes through the charitable organization, Cardiac Risk in the Young (CRY) for young and apparently healthy individuals. Follow-up of individuals with abnormalities at preliminary assessment is provided at a tertiary centre for inherited heart conditions and sports cardiology.

Participants 14,646 subjects aged 16–35 years were evaluated including 4,720 (32%) females and 2,958 (20%) athletes. All individuals underwent health questionnaire, physical examination and 12-lead ECG.

Main Measures ATWI was defined as T wave inversion in 2 or more contiguous anterior leads (V1-V4) and investigated comprehensively to elucidate underlying cardiac pathology. ATWI >-0.1 mV or in 2 or more contiguous leads was considered abnoraml except in V1/III.

Results 338 individuals (2.3%) exhibited ATWI. Those with ATWI were of similar age compared with subjects without ATWI (21.2 (± 5.4) years vs. 21.7 (± 5.3) years). Both groups had a similar mean body surface area. ATWI was more common in females compared with males (n = 203; 4.3% vs n = 135; 1.4%: p < 0.0001) and was more common in athletes than non-athletes in both sexes (females: n = 58; 6.5% vs. n = 145; 3.8%; p = 0.0005, and males: n = 45; 2.1% vs. n = 90; 1.1%; p = 0.0004; see Figure 1). Among athletes, ATWI was more prevalent in those competing in endurance sports than strength sports (n = 82; 5.6% vs. n = 41; 2.8%: p < 0.0001). Noone with ATWI was diagnosed with ARVC after further evaluation.

Univariate predictors of ATWI were female gender and athletic status. Stepwise multiple linear regression identified female gender (hazard ratio 3.1, 95% CI 1.96–4.90, p < 0.001) and athletic status (HR 3.3, 95% CI 1.91–5.63, p = 0.001) as independent predictors irrespective of age.

Conclusions and implications Anterior T wave inversion confined to V1/ V2 may be a normal variant or physiological phenomenon in asymptomatic white individuals without a relevant family history. Conversely, ATWI beyond V2 is rare, particularly in males and may warrant investigation. The results of this study will have a significant impact on ECG interpretation in young white athletes and non-athletes.

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Abstract 149 Figure 1

Diagram illustrating the prevalence of anterior T wave inversion in both sexes