Division of Cardiovascular Sciences, St. George's University of London, United Kingdom.
Department of Cardiology, Universidade Nova de Lisboa, Hospital das Forças Armadas, Luz Saúde, NOVA Medical School, Lisbon, Portugal.
J Am Coll Cardiol. 2017 Jan 3;69(1):1-9. doi: 10.1016/j.jacc.2016.10.044.
Anterior T-wave inversion (ATWI) on electrocardiography (ECG) in young white adults raises the possibility of cardiomyopathy, specifically arrhythmogenic right ventricular cardiomyopathy (ARVC). Whereas the 2010 European consensus recommendations for ECG interpretation in young athletes state that ATWI beyond lead V warrants further investigation, the prevalence and significance of ATWI have never been reported in a large population of asymptomatic whites.
This study investigated the prevalence and significance of ATWI in a large cohort of young, white adults including athletes.
Individuals 16 to 35 years of age (n = 14,646), including 4,720 females (32%) and 2,958 athletes (20%), were evaluated by using a health questionnaire, physical examination, and 12-lead ECG. ATWI was defined as T-wave inversion in ≥2 contiguous anterior leads (V to V).
ATWI was detected in 338 individuals (2.3%) and was more common in women than in men (4.3% vs. 1.4%, respectively; p < 0.0001) and more common among athletes than in nonathletes (3.5% vs. 2.0%, respectively; p < 0.0001). T-wave inversion was predominantly confined to leads V to V (77%). Only 1.2% of women and 0.2% of men exhibited ATWI beyond V. No one with ATWI fulfilled diagnostic criteria for ARVC after further evaluation. During a mean follow-up of 23.1 ± 12.2 months none of the individuals with ATWI experienced an adverse event.
ATWI confined to leads V to V is a normal variant or physiological phenomenon in asymptomatic white individuals without a relevant family history. ATWI beyond V is rare, particularly in men, and may warrant investigation.
心电图（ECG）上年轻白人的前 T 波倒置（ATWI）提示心肌病的可能，特别是致心律失常性右室心肌病（ARVC）。虽然 2010 年欧洲年轻运动员心电图解读共识建议，V 导联以外的 ATWI 需要进一步检查，但在无症状白人的大人群中，从未报道过 ATWI 的患病率和意义。
本研究调查了包括运动员在内的大量年轻白人无症状个体中 ATWI 的患病率和意义。
评估了年龄在 16 至 35 岁的 14646 名个体（n=14646），包括 4720 名女性（32%）和 2958 名运动员（20%），采用健康问卷、体格检查和 12 导联心电图进行评估。ATWI 定义为≥2 个连续前导（V 至 V）的 T 波倒置。
338 名个体（2.3%）检测到 ATWI，女性比男性更常见（分别为 4.3%和 1.4%；p<0.0001），运动员比非运动员更常见（分别为 3.5%和 2.0%；p<0.0001）。T 波倒置主要局限于 V 至 V 导联（77%）。只有 1.2%的女性和 0.2%的男性的 V 导联以外出现 ATWI。进一步评估后，无一人符合 ARVC 的诊断标准。在平均 23.1±12.2 个月的随访期间，无 ATWI 个体发生不良事件。
局限于 V 至 V 导联的 ATWI 是无症状白种个体的正常变异或生理现象，无相关家族史。V 导联以外的 ATWI 罕见，特别是男性，可能需要进一步检查。
