Key result
Athletic participation is linked to ~49% higher prevalence of T-wave inversions vs non-athletes.
Why the study?
T-wave inversions in athletes' ECGs are a challenging finding with uncertain frequency and prognostic significance.
Does the presence of T-wave inversions on ECG indicate a higher risk of structural heart disease or cardiovascular events in athletes?
Meta-Analysis (n=258,954)
Does the presence of T-wave inversions on ECG indicate a higher risk of structural heart disease or cardiovascular events in athletes?
Relative Risk: 1.49 (95% CI 1.13–1.97)
T-wave inversions are more common in athletes than non-athletes, particularly in Black athletes and in anterior leads, but are rarely associated with structural heart disease or adverse cardiovascular events.
Low cardiomyopathy yield with T-wave inversions in athletes supports conservative evaluation; extends prevalence estimates but leaves prognostic implications open.
T-wave inversions (TWI) are a challenging finding in athletes' electrocardiograms. This study aimed to determine the frequency and prognosis of TWI in athletes. A systematic review and meta-analysis were conducted following PRISMA guidelines and registered in PROSPERO (CRD42023494038). Data sources were PubMed, Scopus, and Web of Science. We included original research articles reporting on the prevalence or underlying substrates of TWI and providing data on athletes participating in any type of sports, sex, or race. Risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Tool for Cross-Sectional Studies. Random-effects models were used. Sensitivity and subgroup analyses (sex, age, ethnicity, diagnostic criteria) were predefined. Of 4,509 articles identified, 115 were selected (258,954 individuals). Substantial heterogeneity was observed among the study results. The global TWI prevalence in athletes > 16 years according to the International criteria was 4% (3%, 1%, and 0% in anterior, inferior, and lateral leads, respectively). Prevalence was higher in Black athletes. TWI was more frequent in athletes than non-athletes (prevalence ratio=1.49; 95% confidence interval: 1.13–1.97). Cardiomyopathy diagnosis among athletes with TWI showed high variability, but in most studies, prevalence was <1%. Acute cardiovascular event incidence was low in most of the studies with high heterogeneity. TWI is more frequent in athletes than non-athletes but remains low overall. While it may reflect physiological exercise related ventricular remodelling, thorough evaluation is essential to exclude structural heart disease. The risk of cardiovascular events is uncertain due to low statistical power and high heterogeneity.
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Sanmartin et al. (2026) conducted a meta-analysis in T-wave inversions (n=258,954). Athletic participation vs. Non-athletes was evaluated on Prevalence of T-wave inversions (PR 1.49, 95% CI 1.13-1.97). Athletic participation is associated with a higher frequency of T-wave inversions compared to non-athletes (prevalence ratio 1.49), though the overall prevalence in athletes remains low at 4%.
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