T-wave inversions in elite athletes: the best predictors have yet to be determined

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Deutscher übersetzter Titel:T-Wellen-Inversion bei Elitesportlern : die besten Prädiktoren müssen noch bestimmt werden
Autor:Preßler, Axel; Scherr, Johannes; Wolfarth, Bernd; Halle, Martin
Erschienen in:European heart journal
Veröffentlicht:30 (2009), 23, S. 2947-2948, Lit.
Format: Literatur (SPOLIT)
Publikationstyp: Zeitschriftenartikel
Medienart: Gedruckte Ressource
Sprache:Englisch
ISSN:0195-668X, 1522-9645
DOI:10.1093/eurheartj/ehp449
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Erfassungsnummer:PU201108006497
Quelle:BISp

Abstract

For many years, efforts have been made to elucidate the significance of altered ECG patterns in athletes, enabling to differentiate between physiological adaptations to regular exercise or underlying structural disorders. The study by Papadakis et al.1 is another interesting investigation focusing on T-wave alterations in the subgroup of adolescent athletes. Although data on prevalence have been published before,2 the intriguing new aspect is the implementation of cardiac MRI into the screening procedure. With an increasing number of normal cardiac MRIs in athletes presenting with ECG abnormalities, diagnostic reliability and clinical judgement will certainly improve. Papadakis et al. state that T-wave inversions beyond lead V2 seem to be physiological in the age group younger than 16 years, but fail to see similar findings in older adolescents. In contrast, others have found a higher prevalence in adult athletes,3,4 leaving an equivocal gap between 16 and 18 years. ECG repolarization abnormalities are associated with increased cardiac dimensions induced by exercise training.3 During the late phase of adolescence, the myocardium is particularly adaptive to exercise training and particularly to endurance exercise. Therefore, a lack of significant ECG abnormalities in this particular age group cannot be readily explained. In the English cohort, elite pure endurance athletes are relatively underrepresented (and the age distribution of sport disciplines is not reported), which might be an explanation for the lower prevalence of T-wave inversions in adolescents between 16 and 18 years. From our database including more than 2000 Caucasian elite athletes from endurance sports (e.g. cross-country skiing) competing on national and international levels, we cannot confirm the results presented. In a selection of athletes with enlarged hearts, in whom cardiac disorders were excluded by clinical assessment, laboratory analysis, echocardiography, and exercise testing, we did observe significant T-wave inversions in almost 13%, and beyond lead V2 in 10%. In accordance with the English cohort, we confirm the results for deep T-wave inversions in lateral or inferior leads, which are of similar rarity in our athlete population. Therefore, future studies on ECG abnormalities should particularly focus on this age group of adolescents having been engaged in competitive endurance sports since childhood. They should be characterized regarding maximum and aerobic exercise capacity in addition to training history and echocardiography in order to yield more precise information on whether T-wave inversions in anterior pre-cordial ECG leads are still physiological or should be further investigated. Verf.-Referat