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Race- and Sex-Associated Electrocardiographic Repolarization Characteristics in Young American Athletes in the
Jason V Tso1, Samuel Montalvo2, Filipe Ferrari3
1Division of Cardiovascular Medicine, Stanford Center for Inherited Cardiovascular Disease, Stanford, California, USA; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.
Background:
The 2017 International Criteria for electrocardiographic (ECG) Interpretation in athletes include differential interpretation of anterior T-wave inversion (TWI) based on sex and race.
Objectives:
The purpose of this study was to analyze race- and sex-associated TWI differences and T-wave amplitudes in a digital ECG database of American athletes.
Methods:
The authors analyzed 8,758 athlete screening ECGs (mean age 18.5 ± 3.0 years; 58.7% male). TWI was defined as inversion <-0.075 mV (0.75 mm) to correlate with visual assessment. The convex anterior TWI pattern, historically attributed to Black athletes, was identified by J-point elevation >0.075 mV with convex ST morphology preceding TWI in >1 lead from V2 to V4.
Results:
TWI in ≥1 precordial lead (V1-V6) was present in 58% of athletes, and 7.5% had TWI in V2-V4. TWI was more common in females than males in V1 (80.6% vs 48.7%; P < 0.001), V2 (14.9% vs 4.4%; P < 0.001), and V3 (1.6% vs 0.3%; P < 0.001). Among males, TWI in V4-V6, II, and aVF was more common in Black than non-Black athletes. The convex anterior TWI pattern was rare overall (0.26%, n = 23), without sex- or race-associated differences (0.25% Black vs 0.27% non-Black athletes; P = 1.00). T-wave amplitude was associated with male sex and lower heart rate but not race.
Conclusions:
Anterior TWIs are common in young American athletes, with sex differences but minimal racial variation. The similar prevalence of the convex anterior TWI pattern suggests this pattern may be a normal finding in all races. Our findings offer digital reference values that may refine future ECG screening guidelines.
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