Anterior T-wave inversion in young white athletes and nonathletes: prevalence and significance

Background Anterior T-wave inversion (ATWI) on electrocardiography (ECG) in young white adults raises the possibility of cardiomyopathy, specifically arrhythmogenic right ventricular cardiomyopathy (ARVC). Whereas the 2010 European consensus recommendations for ECG interpretation in young athletes state that ATWI beyond lead V ₁ warrants further investigation, the prevalence and significance of ATWI have never been reported in a large population of asymptomatic whites. Objectives This study investigated the prevalence and significance of ATWI in a large cohort of young, white adults including athletes. Methods Individuals 16 to 35 years of age (n = 14,646), including 4,720 females (32%) and 2,958 athletes (20%), were evaluated by using a health questionnaire, physical examination, and 12-lead ECG. ATWI was defined as T-wave inversion in ≥2 contiguous anterior leads (V ₁ to V ₄). Results ATWI was detected in 338 individuals (2.3%) and was more common in women than in men (4.3% vs. 1.4%, respectively; p < 0.0001) and more common among athletes than in nonathletes (3.5% vs. 2.0%, respectively; p < 0.0001). T-wave inversion was predominantly confined to leads V ₁ to V ₂ (77%). Only 1.2% of women and 0.2% of men exhibited ATWI beyond V ₂. No one with ATWI fulfilled diagnostic criteria for ARVC after further evaluation. During a mean follow-up of 23.1 ± 12.2 months none of the individuals with ATWI experienced an adverse event. Conclusions ATWI confined to leads V ₁ to V ₂ is a normal variant or physiological phenomenon in asymptomatic white individuals without a relevant family history. ATWI beyond V ₂ is rare, particularly in men, and may warrant investigation.