What is the clinical evidence from this study?

Study design: Cohort. Population: High school athletes (n=16893). Intervention: T wave inversion (TWI) in ≥2 contiguous leads. Primary outcome: Prevalence of T wave inversion (TWI) in ≥2 consecutive leads.

What does this research mean for the field?

T wave inversion in ≥2 contiguous leads is rare (0.36%) among US high school athletes, with the inferior+lateral TWI pattern being specifically associated with all identified cases of hypertrophic cardiomyopathy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the prevalence, anatomical distribution patterns, and long-term clinical cardiac outcomes of T wave inversions detected during preparticipation screening electrocardiograms in adolescent athletes.

September 5, 2026British Journal of Sports Medicine

Prevalence and cardiac outcomes of T wave inversions in high school athletes: an analysis of 15 years of preparticipation screening ECGs

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Why the study?

The prevalence, distribution pattern, and clinical relevance of T wave inversion on preparticipation screening 12-lead ECG in high school athletes needed characterisation.

Population

16 893 high school athletes screened during preparticipation events

Comparison

Athletes with T wave inversion in ≥2 contiguous leads vs those without

Design

Retrospective cohort study

Key result

T wave inversion in ≥2 contiguous leads was rare (0.36%) among 16,893 screened US high school athletes, with all 4 cases of hypertrophic cardiomyopathy occurring in those with inferior+lateral TWI.

Authors

ZMZachary P. Morehouse DPDermot Phelan DPDavid E. Price

Discussion

Member takes

Overview

Inferior+lateral TWI may prompt further HCM evaluation in high school athletes; extends ECG screening data but leaves risk stratification hypothesis-generating.

Key Points

To evaluate the prevalence, anatomical distribution patterns, and long-term clinical cardiac outcomes of T wave inversions detected during preparticipation screening electrocardiograms in adolescent athletes.
Retrospective cohort study analyzing 12-lead ECGs from 16,893 high school athletes (mean age 15.3±1.1 years) screened between 2010 and 2025.
Identified athletes with T wave inversions (TWI) in ≥2 contiguous leads and evaluated longitudinal cardiac outcomes via electronic health records, semistructured interviews, and mortality registries.
TWI in ≥2 contiguous leads was present in 61 athletes (0.36%), accounting for 20.2% of all flagged abnormal ECGs; the majority were male (83.6%, n=51), with 75.4% (n=46) in Black males and 23.0% (n=14) in non-Black males.
The most prevalent distribution was anterior+lateral+inferior TWI (27.9%, n=17).
Hypertrophic cardiomyopathy was diagnosed or presumed in 4 male athletes (all exhibiting inferior+lateral TWI), including one who suffered a cardiac arrest two years post-screening.

Study Design

Type

Cohort (n=16,893)

Structured PICO

Population

16,893 US high school athletes (mean age 15.3 years) screened with 12-lead ECGs between 2010 and 2025 to assess the prevalence and clinical relevance of T wave inversions.

Exposure

Preparticipation 12-lead ECG screening

Outcome

Prevalence, distribution pattern, and longitudinal cardiac outcomes of T wave inversion (TWI)

T wave inversion is rare (0.36%) on screening ECGs in US high school athletes, but an inferior+lateral pattern warrants comprehensive assessment due to its association with hypertrophic cardiomyopathy.

Cite This Study

Morehouse et al. (2026) conducted a cohort in High school athletes (n=16,893). T wave inversion (TWI) in ≥2 contiguous leads was evaluated on Prevalence of T wave inversion (TWI) in ≥2 consecutive leads. T wave inversion in ≥2 contiguous leads was rare (0.36%) among 16,893 screened US high school athletes, with all 4 cases of hypertrophic cardiomyopathy occurring in those with inferior+lateral TWI.

synapsesocial.com/papers/6a9bd3e16b95aff0620eb144 https://doi.org/10.1136/bjsports-2025-111510

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September 5, 2026British Journal of Sports Medicine

Prevalence and cardiac outcomes of T wave inversions in high school athletes: an analysis of 15 years of preparticipation screening ECGs

View Full Paper

Ask AI

Bookmark

Why the study?

The prevalence, distribution pattern, and clinical relevance of T wave inversion on preparticipation screening 12-lead ECG in high school athletes needed characterisation.

Population

16 893 high school athletes screened during preparticipation events

Comparison

Athletes with T wave inversion in ≥2 contiguous leads vs those without

Design

Retrospective cohort study

Key result

T wave inversion in ≥2 contiguous leads was rare (0.36%) among 16,893 screened US high school athletes, with all 4 cases of hypertrophic cardiomyopathy occurring in those with inferior+lateral TWI.

Authors

ZMZachary P. Morehouse DPDermot Phelan DPDavid E. Price

Discussion

Member takes

Overview

Inferior+lateral TWI may prompt further HCM evaluation in high school athletes; extends ECG screening data but leaves risk stratification hypothesis-generating.

Key Points

To evaluate the prevalence, anatomical distribution patterns, and long-term clinical cardiac outcomes of T wave inversions detected during preparticipation screening electrocardiograms in adolescent athletes.
Retrospective cohort study analyzing 12-lead ECGs from 16,893 high school athletes (mean age 15.3±1.1 years) screened between 2010 and 2025.
Identified athletes with T wave inversions (TWI) in ≥2 contiguous leads and evaluated longitudinal cardiac outcomes via electronic health records, semistructured interviews, and mortality registries.
TWI in ≥2 contiguous leads was present in 61 athletes (0.36%), accounting for 20.2% of all flagged abnormal ECGs; the majority were male (83.6%, n=51), with 75.4% (n=46) in Black males and 23.0% (n=14) in non-Black males.
The most prevalent distribution was anterior+lateral+inferior TWI (27.9%, n=17).
Hypertrophic cardiomyopathy was diagnosed or presumed in 4 male athletes (all exhibiting inferior+lateral TWI), including one who suffered a cardiac arrest two years post-screening.

Study Design

Type

Cohort (n=16,893)

Structured PICO

Population

16,893 US high school athletes (mean age 15.3 years) screened with 12-lead ECGs between 2010 and 2025 to assess the prevalence and clinical relevance of T wave inversions.

Exposure

Preparticipation 12-lead ECG screening

Outcome

Prevalence, distribution pattern, and longitudinal cardiac outcomes of T wave inversion (TWI)

Cite This Study

synapsesocial.com/papers/6a9bd3e16b95aff0620eb144 https://doi.org/10.1136/bjsports-2025-111510

View Full Paper

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