![]() The aim of this review is, therefore, to report an update of the literature on TWI in athletes, with a specific focus on the interpretation and management, including the advice for eligibility and/or disqualification from competitions.įor a proper interpretation of TWI patterns in athletes, it is crucial to consider primarily the TWI localization, which may be helpful to identify specific cardiac pathologies, in association with the family and personal history and the clinical correlates of the TWI.Īnterior TWI is defined as negative T wave in precordial leads exceeding V1. In some cases, the identification of TWI should be viewed as a red flag on the ECG of young and apparently healthy athletes and warrants further investigations, having in mind that it may represent the initial expression of cardiomyopathies that may not be evident until many years later and that may ultimately be associated with adverse outcomes. TWI may be occasionally seen in healthy athletes presenting signs of cardiac remodeling, such as left ventricular (LV) hypertrophy, atrial dilation, increase in ventricular cavity size, which may occasionally overlap with those of life‐threatening arrhythmogenic cardiomyopathies. The interpretation of TWI in athletes is complex and the inherent implications for the clinical practice represent a conundrum for physicians. The presence of TWI at 12‐lead electrocardiogram (ECG) in competitive athletes is one of the major diagnostic challenges for sports physicians and consulting cardiologists. T‐wave inversion (TWI) is defined as negative T‐wave of ≥1 mm in depth in two or more contiguous leads, with exclusion of leads aVR, III, and V1. The aim of this review is, therefore, to report an update of the literature on TWI in athletes, with a specific focus on the interpretation and management. Accordingly, the detection of TWI should be viewed as a potential red flag on the ECG of young and apparently healthy athletes and warrants further investigations because it may represent the initial expression of cardiomyopathies that may not be evident until many years later and that may ultimately be associated with adverse outcomes. ![]() ![]() Indeed, while the presence of TWI may be associated with some benign conditions and it may be occasionally seen in healthy athletes presenting signs of cardiac remodeling, it may also represent an early sign of an underlying, concealed structural heart disease or life‐threatening arrhythmogenic cardiomyopathies, which may be responsible for exercise‐related sudden cardiac death (SCD). The presence of T‐wave inversion (TWI) at 12‐lead electrocardiogram (ECG) in competitive athletes is one of the major diagnostic challenges for sports physicians and consulting cardiologists. ![]()
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