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September 5, 2026British Journal of Sports Medicine

Screening ECG TWI occurs in ~0.4% of athletes, with inferior-lateral patterns identifying all HCM cases.

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Population

16,893 US high school athletes screened between 2010 and 2025 during a preparticipation event, focusing on…

Design

Cohort

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. MorehouseDPDermot PhelanDPDavid E. Price

Discussion

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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

P
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.
E
Exposure
Preparticipation 12-lead ECG screening
O
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/6a9bd3e16b95aff0620eb144https://doi.org/10.1136/bjsports-2025-111510
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Isolated Anterior T‐Wave Inversion in Elite Athletes: Prevalence and Clinical Relevance by Sex and Sporting Discipline2025
  2. 2Electrocardiographic anterior T-wave inversion in athletes of different ethnicities: differential diagnosis between athlete's heart and cardiomyopathy2015 · 116 citations
  3. 3Prevalence and significance of anterior T-wave inversion in professional football players in the UK2026
  4. 4Sport- and sex-specific ECG patterns in competitive athletes2026
  5. 5Prevalence and relation to training of electrocardiographic findings in Caucasian children and adolescents 8-18 year-old practicing competitive sport.2025 · 4 citations