Significance of deep T-wave inversions in asymptomatic athletes with normal cardiovascular examinations: practical solutions for managing the diagnostic conundrum
Identifieur interne : 000073 ( France/Analysis ); précédent : 000072; suivant : 000074Significance of deep T-wave inversions in asymptomatic athletes with normal cardiovascular examinations: practical solutions for managing the diagnostic conundrum
Auteurs : M G Wilson [Qatar] ; S. Sharma [Royaume-Uni] ; F. Carré [Royaume-Uni] ; P. Charron [France] ; P. Richard [France] ; R. O'Hanlon [France] ; S K Prasad [Irlande (pays)] ; H. Heidbuchel [Royaume-Uni] ; J. Brugada [Belgique] ; O. Salah [Espagne] ; M. Sheppard [Qatar] ; K P George [Royaume-Uni] ; G. Whyte [Royaume-Uni] ; B. Hamilton [Royaume-Uni] ; H. Chalabi [Qatar]Source :
- British Journal of Sports Medicine [ 0306-3674 ] ; 2012-11.
Abstract
Preparticipation screening programmes for underlying cardiac pathologies are now commonplace for many international sporting organisations. However, providing medical clearance for an asymptomatic athlete without a family history of sudden cardiac death (SCD) is especially challenging when the athlete demonstrates particularly abnormal repolarisation patterns, highly suggestive of an inherited cardiomyopathy or channelopathy. Deep T-wave inversions of ≥2 contiguous anterior or lateral leads (but not aVR, and III) are of major concern for sports cardiologists who advise referring team physicians, as these ECG alterations are a recognised manifestation of hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC). Subsequently, inverted T-waves may represent the first and only sign of an inherited heart muscle disease, in the absence of any other features and before structural changes in the heart can be detected. However, to date, there remains little evidence that deep T-wave inversions are always pathognomonic of either a cardiomyopathy or an ion channel disorder in an asymptomatic athlete following long-term follow-up. This paper aims to provide a systematic review of the prevalence of T-wave inversion in athletes and examine T-wave inversion and its relationship to structural heart disease, notably HCM and ARVC with a view to identify young athletes at risk of SCD during sport. Finally, the review proposes clinical management pathways (including genetic testing) for asymptomatic athletes demonstrating significant T-wave inversion with structurally normal hearts.
Url:
DOI: 10.1136/bjsports-2011-090838
Affiliations:
- Belgique, Espagne, France, Irlande (pays), Qatar, Royaume-Uni
- Angleterre, Catalogne, Grand Londres
- Barcelone, Londres, Paris, Rennes
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ISTEX:0B19180B963CD7284CA1D7ED9734A4436291C597Le document en format XML
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O'Hanlon</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>AP-HP, Functional Unit of Cardiogenetics and Myogenetics, Centre de Génétique, Hôpital Pitié Salpêtrière, Paris</wicri:regionArea><placeName><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Prasad, S K" sort="Prasad, S K" uniqKey="Prasad S" first="S K" last="Prasad">S K Prasad</name><affiliation wicri:level="1"><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea>St Vincent's University Hospital and The Blackrock Clinic, Dublin</wicri:regionArea><wicri:noRegion>Dublin</wicri:noRegion></affiliation></author><author><name sortKey="Heidbuchel, H" sort="Heidbuchel, H" uniqKey="Heidbuchel H" first="H" last="Heidbuchel">H. Heidbuchel</name><affiliation wicri:level="3"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Cardiac Magnetic Resonance Imaging, Royal Brompton and Harefield NHS Trust, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Brugada, J" sort="Brugada, J" uniqKey="Brugada J" first="J" last="Brugada">J. Brugada</name><affiliation wicri:level="1"><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Cardiovascular Medicine, University of Leuven, Leuven</wicri:regionArea><wicri:noRegion>Leuven</wicri:noRegion></affiliation></author><author><name sortKey="Salah, O" sort="Salah, O" uniqKey="Salah O" first="O" last="Salah">O. Salah</name><affiliation wicri:level="3"><country xml:lang="fr">Espagne</country><wicri:regionArea>Hospital Clínic, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Sheppard, M" sort="Sheppard, M" uniqKey="Sheppard M" first="M" last="Sheppard">M. 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Hamilton</name><affiliation wicri:level="1"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool</wicri:regionArea><wicri:noRegion>Liverpool</wicri:noRegion></affiliation><affiliation wicri:level="3"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Sports Cardiology, 76 Harley Street, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Chalabi, H" sort="Chalabi, H" uniqKey="Chalabi H" first="H" last="Chalabi">H. Chalabi</name><affiliation wicri:level="1"><country xml:lang="fr">Qatar</country><wicri:regionArea>ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha</wicri:regionArea><wicri:noRegion>Doha</wicri:noRegion></affiliation></author></analytic><monogr></monogr><series><title level="j">British Journal of Sports Medicine</title><title level="j" type="abbrev">Br J Sports Med</title><idno type="ISSN">0306-3674</idno><idno type="eISSN">1473-0480</idno><imprint><publisher>BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine</publisher><date type="published" when="2012-11">2012-11</date><biblScope unit="volume">46</biblScope><biblScope unit="issue">Suppl 1</biblScope><biblScope unit="page" from="51">i51</biblScope></imprint><idno type="ISSN">0306-3674</idno></series><idno type="istex">0B19180B963CD7284CA1D7ED9734A4436291C597</idno><idno type="DOI">10.1136/bjsports-2011-090838</idno><idno type="href">bjsports-46-i51.pdf</idno><idno type="ArticleID">bjsports-2011-090838</idno><idno type="local">bjsports;46/Suppl_1/i51</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0306-3674</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Preparticipation screening programmes for underlying cardiac pathologies are now commonplace for many international sporting organisations. However, providing medical clearance for an asymptomatic athlete without a family history of sudden cardiac death (SCD) is especially challenging when the athlete demonstrates particularly abnormal repolarisation patterns, highly suggestive of an inherited cardiomyopathy or channelopathy. Deep T-wave inversions of ≥2 contiguous anterior or lateral leads (but not aVR, and III) are of major concern for sports cardiologists who advise referring team physicians, as these ECG alterations are a recognised manifestation of hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC). Subsequently, inverted T-waves may represent the first and only sign of an inherited heart muscle disease, in the absence of any other features and before structural changes in the heart can be detected. However, to date, there remains little evidence that deep T-wave inversions are always pathognomonic of either a cardiomyopathy or an ion channel disorder in an asymptomatic athlete following long-term follow-up. This paper aims to provide a systematic review of the prevalence of T-wave inversion in athletes and examine T-wave inversion and its relationship to structural heart disease, notably HCM and ARVC with a view to identify young athletes at risk of SCD during sport. Finally, the review proposes clinical management pathways (including genetic testing) for asymptomatic athletes demonstrating significant T-wave inversion with structurally normal hearts.</div></front></TEI><affiliations><list><country><li>Belgique</li><li>Espagne</li><li>France</li><li>Irlande (pays)</li><li>Qatar</li><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Catalogne</li><li>Grand Londres</li></region><settlement><li>Barcelone</li><li>Londres</li><li>Paris</li><li>Rennes</li></settlement></list><tree><country name="Qatar"><noRegion><name sortKey="Wilson, M G" sort="Wilson, M G" uniqKey="Wilson M" first="M G" last="Wilson">M G Wilson</name></noRegion><name sortKey="Chalabi, H" sort="Chalabi, H" uniqKey="Chalabi H" first="H" last="Chalabi">H. Chalabi</name><name sortKey="Sheppard, M" sort="Sheppard, M" uniqKey="Sheppard M" first="M" last="Sheppard">M. Sheppard</name></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Sharma, S" sort="Sharma, S" uniqKey="Sharma S" first="S" last="Sharma">S. Sharma</name></region><name sortKey="Carre, F" sort="Carre, F" uniqKey="Carre F" first="F" last="Carré">F. Carré</name><name sortKey="George, K P" sort="George, K P" uniqKey="George K" first="K P" last="George">K P George</name><name sortKey="Hamilton, B" sort="Hamilton, B" uniqKey="Hamilton B" first="B" last="Hamilton">B. Hamilton</name><name sortKey="Hamilton, B" sort="Hamilton, B" uniqKey="Hamilton B" first="B" last="Hamilton">B. Hamilton</name><name sortKey="Heidbuchel, H" sort="Heidbuchel, H" uniqKey="Heidbuchel H" first="H" last="Heidbuchel">H. Heidbuchel</name><name sortKey="Whyte, G" sort="Whyte, G" uniqKey="Whyte G" first="G" last="Whyte">G. Whyte</name></country><country name="France"><noRegion><name sortKey="Charron, P" sort="Charron, P" uniqKey="Charron P" first="P" last="Charron">P. Charron</name></noRegion><name sortKey="O Hanlon, R" sort="O Hanlon, R" uniqKey="O Hanlon R" first="R" last="O'Hanlon">R. O'Hanlon</name><name sortKey="Richard, P" sort="Richard, P" uniqKey="Richard P" first="P" last="Richard">P. Richard</name></country><country name="Irlande (pays)"><noRegion><name sortKey="Prasad, S K" sort="Prasad, S K" uniqKey="Prasad S" first="S K" last="Prasad">S K Prasad</name></noRegion></country><country name="Belgique"><noRegion><name sortKey="Brugada, J" sort="Brugada, J" uniqKey="Brugada J" first="J" last="Brugada">J. Brugada</name></noRegion></country><country name="Espagne"><region name="Catalogne"><name sortKey="Salah, O" sort="Salah, O" uniqKey="Salah O" first="O" last="Salah">O. Salah</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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