Abstract

Aims To determine the clinical significance of T wave depth and T wave/QRS voltage ratio in young individuals who exhibit TWI on ECG performed as part of cardiac screening. Methods We analysed an electronic database of individuals aged 14-35 years who underwent voluntary cardiac screening between 2008 and 2013. The prevalence of TWI, the lead distribution, the T wave depth and the T wave/QRS voltage ratio were assessed. Follow-up information was available for all subjects, including data regarding diagnosis of cardiac disease and major cardiac events. Results The cohort consisted of 5360 individuals and TWI was documented in 120 (2%) cases. After further investigations, a diagnosis of cardiomyopathy was made in 16 cases. Individuals who were eventually diagnosed with cardiomyopathy exhibited more frequently TWI in multiple territories than individuals who did not receive a diagnosis at follow-up. T waves were deeper (p=0.03) in the former compared to the latter, but no significant difference in T/QRS ratio was observed. The cut-off value of TWI depth that best differentiated between presence and absence of cardiomyopathy was 0.183 mV; ROC curve analysis showed an AUC of 0.767. During a mean follow-up of 8.1±1.2 years, no deaths were documented, but 3 of the 16 patients experienced a sudden cardiac arrest (all of them were diagnosed with arrhythmogenic cardiomyopathy). Conclusions T wave inversion is a relatively common ECG finding in young apparently healthy individuals. The distribution on multiple lead territories and deeper T waves are early indicators of an underlying cardiomyopathy.