Key result
T-wave inversion in athletes links to underlying cardiac disorders in up to ~20% of cases.
This narrative review highlights that while 80% of T-wave inversions in athletes remain unexplained, up to 20% reflect underlying structural or electrical cardiac disorders that can lead to sports-related sudden cardiac death, necessitating standardized evaluation protocols.
Answers are grounded in this paper and cite their sources.
May warrant targeted evaluation in athletes; leaves open etiology, mechanisms, and risk stratification in most cases.
This narrative review synthesizes research conducted in Russia and other countries on the causes of T-wave inversion (TWI) on athletes’ electrocardiograms (ECGs). TWI is one of the most common ECG patterns observed in living athletes and, based on retrospective ECG analyses, in athletes who later died; it is recorded substantially more often in athletes than in age-matched individuals in the general population. TWI may reflect age- or ethnicity-related characteristics and may represent either a physiological or a pathological finding. Up to 20% of athletes with TWI have an underlying structural or electrical cardiac disorder, such as cardiomyopathy, myocarditis, mitral valve prolapse, coronary artery disease, myocardial fibrosis, or a channelopathy; these conditions can lead to sports-related sudden cardiac death. However, no specific heart disease is diagnosed in 80% of athletes with TWI despite comprehensive clinical evaluation and long-term follow-up. Such cases are classified as unexplained TWI. The review examines differing views on the origin and prognosis of unexplained TWI in athletes, including the hypothesis that TWI induced by intense exercise is a manifestation of exercise-induced cardiomyopathy. These exercise-related myocardial abnormalities are currently attributed to repetitive myocardial injury caused by intense exercise. The evidence underscores the need for sport-specific recommendations, standardized protocols for identifying athletes at risk of sports-related sudden cardiac death, and additional training for physicians responsible for athletes’ medical care. On the basis of current evidence, the review proposes practical recommendations for interpreting TWI in athletes.
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Gavrilova et al. (2026) conducted a review in T-wave inversion on electrocardiogram in athletes. Electrocardiogram evaluation for T-wave inversion was evaluated on Underlying structural or electrical cardiac disorder vs unexplained T-wave inversion. T-wave inversion in athletes is associated with an underlying structural or electrical cardiac disorder in up to 20% of cases, while 80% remain unexplained.
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