Multimodality imaging for negative T waves among athletes with normal transthoracic echocardiography: prevalence and prognosis of structural heart disease

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The aim of the present study was to evaluate the prevalence of structural heart disease (SHD) among competitive athletes with negative T waves without pathological findings at transthoracic echocardiogram, evaluated at cardiac MRI and cardiac CT. Methods 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. Results A total of 55 competitive athletes were finally enrolled (50 males, 90%) with a mean age of 27.5±14.1 years old. 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. Conclusion In an unselected 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.