Br J Sports Med. 2026 Sep 3:bjsports-2025-111510. doi: 10.1136/bjsports-2025-111510. Online ahead of print.
ABSTRACT
OBJECTIVE: To characterise the prevalence, distribution pattern and clinical relevance of T wave inversion (TWI) on a screening preparticipation 12-lead ECG in high school athletes.
METHODS: A retrospective cohort study analysed ECGs from athletes screened between 2010 and 2025 during a preparticipation event. Athletes with TWI in ≥2 contiguous leads were included. Longitudinal cardiac outcomes were assessed via electronic health records, semistructured interviews and extensive media and death registries review.
RESULTS: Among 16 893 high school athletes screened (mean age 15.3±1.1 years), 61 (0.36%) demonstrated TWI in ≥2 consecutive leads, representing 20.2% of those flagged with abnormal ECGs. The majority of athletes with TWI were male (n=51, 83.6%), with 46 (75.4%) in black and 14 (23.0%) in non-black male athletes. Anterior+lateral + inferior TWI was the most frequent pattern (n=17, 27.9%). Four male athletes were identified with confirmed or presumed hypertrophic cardiomyopathy (HCM); two identified after screening, one identified 5 years after screening and one lost to follow-up who did not complete the diagnostic evaluation until after a cardiac arrest 2 years later.
CONCLUSION: Abnormal TWI was rare in this large US adolescent athlete cohort, with higher prevalence among black males. All confirmed or presumed cases of HCM occurred in athletes with inferior+lateral TWI, underscoring the importance of a comprehensive assessment and longitudinal surveillance in athletes with this ECG phenotype.
PMID:42692801 | DOI:10.1136/bjsports-2025-111510