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Prevalence and significance of T-wave inversion in Arab and Black paediatric athletes: Should anterior T-wave inversion interpretation be governed by biological or chronological age?

Authors
  • McClean, Gavin1, 2
  • Riding, Nathan R1
  • Pieles, Guido3
  • Sharma, Sanjay4
  • Watt, Victoria5
  • Adamuz, Carmen5
  • Johnson, Amanda6
  • Tramullas, Antonio6
  • George, Keith P2
  • Oxborough, David2
  • Wilson, Mathew G1, 2
  • 1 1 Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Qatar. , (Qatar)
  • 2 2 Research Institute for Sport and Exercise Science, Liverpool John Moores University, UK.
  • 3 3 National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Bristol Royal Hospital for Children and Bristol Heart Institute, UK.
  • 4 4 Department of Cardiovascular Sciences, St Georges University of London, UK.
  • 5 5 Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Qatar. , (Qatar)
  • 6 6 Aspire Academy Sports Medicine Centre, Aspire Academy, Qatar. , (Qatar)
Type
Published Article
Journal
European Journal of Preventive Cardiology
Publisher
SAGE Publications
Publication Date
Nov 14, 2018
Identifiers
DOI: 10.1177/2047487318811956
PMID: 30426769
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

International electrocardiographic (ECG) recommendations regard anterior T-wave inversion (ATWI) in athletes under 16 years to be normal. The aim of this study was to identify the prevalence, distribution and determinants of TWI by ethnicity, chronological and biological age within paediatric athletes. A second aim was to establish the diagnostic accuracy of international ECG recommendations against refinement within athletes who present with ECG variants isolated to ATWI (V1-V4) using receiver operator curve analysis. Clinical context was calculated using Bayesian analysis. Four hundred and eighteen Arab and 314 black male athletes (11-18 years) were evaluated by ECG, echocardiogram and biological age (by radiological X-ray) assessment. A total of 116 (15.8%) athletes presented with ATWI (V1-V4), of which 96 (82.8%) were observed in the absence of other ECG findings considered to be abnormal as per international recommendations for ECG interpretation in athletes; 91 (12.4%) athletes presented with ATWI confined to V1-V3, with prevalence predicted by black ethnicity (odds ratio (OR) 2.2, 95% confidence interval (CI) 1.3-3.5) and biological age under 16 years (OR 2.0, 95% CI 1.2-3.3). Of the 96 with ATWI (V1-V4) observed in the absence of other ECG findings considered to be abnormal, as per international recommendations for ECG interpretation in athletes, diagnostic accuracy was 'fail' (OR 0.47, 95% CI 0.00-1.00) for international recommendations and 'excellent' (OR 0.97, 95% CI 0.92-1.00) when governed by biological age under 16 years, providing a positive and negative likelihood ratio of 15.8 (95% CI 1.8-28.1) and 0.0 (95% CI 0.0-0.8), respectively. Interpretation of ECG variants isolated with ATWI (V1-V4) using international recommendations (chronological age <16 years) warrants caution, but governance by biological age yielded an 'excellent' diagnostic accuracy. In the clinical context, the 'chance' of detecting cardiac pathology within a paediatric male athlete presenting with ATWI in the absence of other ECG findings considered to be abnormal, as per international recommendations for ECG interpretation in athletes (positive likelihood ratio 15.8), was 14.4%, whereas a negative ECG (negative likelihood ratio 0.0) was 0%.

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