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Echocardiographic findings in 2261 peri-pubertal athletes with or without inverted T waves at electrocardiogram
  1. Leonardo Calò1,
  2. Fabio Sperandii1,2,
  3. Annamaria Martino1,
  4. Emanuele Guerra1,2,
  5. Elena Cavarretta3,4,
  6. Federico Quaranta2†,
  7. Ermenegildo de Ruvo1,
  8. Luigi Sciarra1,
  9. Attilio Parisi2,
  10. Antonia Nigro3,
  11. Antonio Spataro5,
  12. Fabio Pigozzi2
  1. 1Division of Cardiology, Policlinico Casilino, ASL Rome B, Rome, Italy
  2. 2Department of Health Sciences, University of Rome “Foro Italico”, Rome, Italy
  3. 3The FMSI Sport Medicine Institute, Villa Stuart Sport Clinic—FIFA Centre of Excellence, Rome, Italy
  4. 4Department of Medical-Surgical Sciences and Biotechnologies, University of Rome “La Sapienza”, Rome, Italy
  5. 5Institute of Sports Medicine and Science (CONI), Rome, Italy
  1. Correspondence to Professor Leonardo Calò, Division of Cardiology, Policlinico Casilino, ASL Rome B, Via Casilina 1049, Rome 00169, Italy; leonardo.calo{at}


Objective T wave inversion (TWI) has been associated with cardiomyopathies. The hypothesis of this study was that TWI has relevant clinical significance in peri-pubertal athletes.

Methods Consecutive male soccer players, aged 8–18 years, undergoing preparticipation screening between January 2008 and March 2009 were enrolled. Medical and family histories were collected; physical examinations, 12-lead ECGs and transthoracic echocardiogram (TTE) were performed. TWI was categorised by ECG lead (anterior (V1–V3), extended anterior (V1–V4), inferior (DII–aVF) and infero-lateral (DII–aVF/V4–V6/DI-aVL)) and by age.

Results Overall, 2261 (mean age 12.4 years, 100% Caucasian) athletes were enrolled. TWI in ≥2 consecutive ECG leads was found in 136 athletes (6.0%), mostly in anterior leads (126/136, 92.6%). TWI in anterior leads was associated with TTE abnormalities in 6/126 (4.8%) athletes. TWI in extended anterior (2/136, 1.5%) and inferior (3/136, 2.2%) leads was never associated with abnormal TTE. TWI in infero-lateral leads (5/136, 3.7%) was associated with significant TTE abnormalities (3/5, 60.0%), including one hypertrophic cardiomyopathy (HCM) and two LV hypertrophies. Athletes with normal T waves had TTE abnormalities in 4.4% of cases, including one HCM with deep Q waves in infero-lateral leads.

Conclusions In this broad population of peri-pubertal male athletes, TWI in anterior leads was associated with mild cardiac disease in 4.8% of cases, while TWI in infero-lateral leads revealed HCM and LV hypertrophy in 60% of cases. ECG identified all cases of HCM.


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