Centro Cardiologico Monzino IRCCS, Milan, Italy.
Department of Biomedical Science for Health, University of Milan, Milan, Italy.
Clin Res Cardiol. 2024 May;113(5):706-715. doi: 10.1007/s00392-023-02282-5. Epub 2023 Aug 15.
The aim of the present study was to evaluate the prevalence and prognosis of structural heart disease (SHD) among competitive athletes with negative T waves without pathological findings at transthoracic echocardiogram.
From a prospective register of 450 athletes consecutively evaluated during a second-level cardiological examination, we retrospectively identified all subjects with the following inclusion criteria: (1) not previously known cardiovascular disease; (2) negative T waves in leads other than V1-V2; (3) normal transthoracic echocardiogram. Patients underwent cardiac MRI and CT. The primary endpoint was the diagnosis of definite SHD after multimodality imaging evaluation. A follow-up was collected for a combined end-point of sudden death, resuscitated sudden cardiac death and hospitalization for any cardiovascular causes.
A total of 55 competitive athletes were finally enrolled (50 males, 90%) with a mean age of 27.5 ± 14.1 years. Among the population enrolled 16 (29.1%) athletes had a final diagnosis of SHD. At multivariate analysis, only deep negative T waves remained statistically significant [OR (95% CI) 7.81 (1.24-49.08), p = 0.0285]. Contemporary identification of deep negative T waves and complex arrhythmias in the same patients appeared to have an incremental diagnostic value. No events were collected at 49.3 ± 12.3 months of follow-up.
In a cohort of athletes with negative T waves at ECG, cardiac MRI (and selected use of cardiac CT) enabled the identification of 16 (29.1%) subjects with SHD despite normal transthoracic echocardiography. Deep negative T waves and complex ventricular arrhythmias were the only clinical characteristic associated with SHD diagnosis.
本研究旨在评估在经胸超声心动图无病理发现的情况下，心电图 T 波倒置而无结构性心脏病（SHD）的竞技运动员的患病率和预后。
从一个连续评估的 450 名运动员的前瞻性登记中，我们回顾性地确定了所有符合以下纳入标准的患者：（1）无已知心血管疾病；（2）V1-V2 导联以外的 T 波倒置；（3）经胸超声心动图正常。患者接受心脏 MRI 和 CT。主要终点是多模态影像学评估后确诊为明确 SHD。收集了一个复合终点的随访数据，包括猝死、复苏性心源性猝死和因任何心血管原因住院。
最终共纳入 55 名竞技运动员（50 名男性，90%），平均年龄为 27.5±14.1 岁。在纳入的人群中，16 名（29.1%）运动员最终诊断为 SHD。多变量分析显示，只有深 T 波倒置仍然具有统计学意义[比值比（95%可信区间）7.81（1.24-49.08），p=0.0285]。在同一患者中同时出现深 T 波倒置和复杂心律失常似乎具有增量诊断价值。在 49.3±12.3 个月的随访中未发生任何事件。
在心电图 T 波倒置的运动员队列中，心脏 MRI（并选择性使用心脏 CT）能够识别出 16 名（29.1%）尽管经胸超声心动图正常但仍存在 SHD 的患者。深 T 波倒置和复杂室性心律失常是唯一与 SHD 诊断相关的临床特征。
