Right Precordial T-Wave Inversion in Healthy Endurance Athletes Can Be Explained by Lateral Displacement of the Cardiac Apex

Maria J Brosnan; Guido Claessen; Hein Heidbuchel; David L Prior; Andre La Gerche

doi:10.1016/j.jacep.2015.03.007

Right Precordial T-Wave Inversion in Healthy Endurance Athletes Can Be Explained by Lateral Displacement of the Cardiac Apex

JACC Clin Electrophysiol. 2015 Mar-Apr;1(1-2):84-91. doi: 10.1016/j.jacep.2015.03.007. Epub 2015 Apr 20.

Authors

Maria J Brosnan¹, Guido Claessen², Hein Heidbuchel³, David L Prior⁴, Andre La Gerche⁵

Affiliations

¹ Department of Cardiology, St. Vincent's Hospital, Fitzroy, Australia; Department of Medicine, St. Vincent's Hospital and University of Melbourne, Fitzroy, Australia. Electronic address: maria.brosnan@svha.org.au.
² Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.
³ Hasselt University and Heart Center, Jessa Hospital, Hasselt, Belgium.
⁴ Department of Cardiology, St. Vincent's Hospital, Fitzroy, Australia; Department of Medicine, St. Vincent's Hospital and University of Melbourne, Fitzroy, Australia.
⁵ Department of Cardiology, St. Vincent's Hospital, Fitzroy, Australia; Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium; Baker IDI Heart and Diabetes Institute, Melbourne, Australia.

PMID: 29759344
DOI: 10.1016/j.jacep.2015.03.007

Abstract

Objectives: The objective of this study was to test the hypothesis that T-wave inversion in the right precordial leads (TWI_V2-3) reflects lateral displacement of the heart such that the surface electrocardiographic (ECG) leads overlie a greater proportion of the right ventricle (RV).

Background: TWI_V2-3 on ECG is more frequently observed among endurance athletes (EAs) than in the general population, the underlying mechanism for which is unclear.

Methods: Sixty-eight EAs and 41 nonathletic control subjects underwent ECG and cardiac magnetic resonance imaging (CMRI). In addition to standard measurements of biventricular function and volume, novel measurements of cardiac displacement and orientation were analyzed from horizontal long-axis images. These included RV wall thickness in diastole (RV_d), cardiac-to-hemithorax area ratio (CHTx%), percentage of circumferential displacement of the RV apex toward the axilla (%LatD), and the angle of interventricular septum with respect to the thoracic midline (∠_septal).

Results: All cardiac volume, RV_d, CHTx%, %LatD, and ∠_septal values were greater in EAs than in controls. Compared to EAs without TWI_V2-3, EAs with TWI_V2-3 (n = 26) did not have greater RV wall thickness or cardiac volumes (RV_d = 4.9 vs. 4.8 mm, p = 0.695; LVEDV = 231 vs. 229 ml, p = 0.856; RVEDV = 257 vs. 254 mL, p = 0.746), but all measurements of cardiac displacement toward the axilla were greater (%LatD = 45.6% vs. 37.9%, respectively, p < 0.0001; ∠_septal = 54.23° vs. 48.63°, respectively, p = 0.001; and CHTx% = 46.3% vs. 41.9%, respectively, p = 0.048).

Conclusions: In healthy EAs, TWI_V2-3 is associated with displacement of the RV toward the left axilla rather than RV dilatation or hypertrophy. TWI_V2-3 may be explained by the position of the RV relative to that of the surface ECG leads.

Keywords: ARVC; CMRI; ECG; athlete; cardiac MRI; cardiac displacement; right ventricle.