Abstract
T-wave inversions (TWI) in inferolateral electrocardiogram (ECG) leads (II, III, aVF, V5–V6) are often suggestive of cardiac pathology in adult patients. They are a common reason of additional testing in pediatric patients. The goal of the study is to determine correlation of exercise stress test T-wave response with diagnosis of cardiac pathology. This is a retrospective review of pediatric patients < 21 years with the finding of baseline TWI in inferior (II, III, avF) and/or lateral (V5–V6) leads on 12-lead ECG. All patients underwent treadmill exercise stress test (EST) and an echocardiogram within 1 year of each other. Demographics, baseline ECG findings, echocardiogram results, and EST data were recorded. T-wave reversion was considered complete if T waves demonstrated normalization during exercise, partial if there was minimal improvement, and no response if there was no change or worsening of inversions. In our cohort of 72 patients with a mean age 14.6 (± 2.9) years and 61% males, 59 (82%) had a structurally normal heart. Thirteen patients had evidence of structural or functional heart disease. Of the 59 patients, 83% had either complete or partial T-wave response. Among the 13 patients with heart disease, two patients had genetic testing consistent with risk for hypertrophic cardiomyopathy and had complete and partial response on EST. Exercise stress testing for TWI in pediatric patients has low sensitivity and specificity for the diagnosis of cardiac disease and routine use in this patient population may not be indicated.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Availability of Data and Material
Patient records.
References
Goodacre S, Mcleod K (2016) Pediatric electrocardiography: pediatric electrocardiography. BMJ 324(7350):1382–5
O’Connor M, McDaniel N, Brady WJ (2008) The pediatric electrocardiogram. Part I: Age-related interpretation. Am J Emerg Med 26(2):221–8
Dickinson DF (2005) The normal ECG in childhood and adolescence. Heart 91(12):1626–1630
D’Ascenzi F, Anselmi F, Adami PE, Pelliccia A (2020) Interpretation of T-wave inversion in physiological and pathological conditions: current state and future perspectives. Clin Cardiol 43(8):827–833
D’Ascenzi F, Anselmi F, Berti B, Capitani E, Chiti C, Franchini A et al (2019) Prevalence and significance of T-wave inversion in children practicing sport: a prospective, 4-year follow-up study. Int J Cardiol [Internet]. 2019(279):100–4. https://doi.org/10.1016/j.ijcard.2018.09.069
Papadakis M, Basavarajaiah S, Rawlins J, Edwards C, Makan J, Firoozi S et al (2009) Prevalence and significance of T-wave inversions in predominantly Caucasian adolescent athletes. Eur Heart J 30(14):1728–1735
Chandra N, Bastiaenen R, Papadakis M, Panoulas VF, Ghani S, Duschl J et al (2014) Prevalence of electrocardiographic anomalies in young individuals: relevance to a nationwide cardiac screening program. J Am Coll Cardiol 63(19):2028–2034
Sheikh N, Papadakis M, Wilson M, Malhotra A, Adamuz C, Homfray T et al (2018) Diagnostic yield of genetic testing in young athletes with t-wave inversion. Circulation 138(12):1184–1194
Magalski A, Maron BJ, Main ML, McCoy M, Florez A, Reid KJ et al (2008) Relation of race to electrocardiographic patterns in Elite American football players. J Am Coll Cardiol 51(23):2250–2255
Pelliccia A, Di Paolo FM, Quattrini FM, Basso C, Culasso F, Popoli G et al (2008) Outcomes in athletes with marked ECG repolarization abnormalities. N Engl J Med 358(2):152–161
Corrado D, Pelliccia A, Heidbuchel H, Sharma S, Link M, Basso C et al (2010) Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J 31(2):243–259
Maron BJ, McKenna WJ, Danielson GK, Kappenberger LJ, Kuhn HJ, Seidman CE et al (2003) American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European S. J Am Coll Cardiol 42(9):1687–1713
Wilson MG, Sharma S, Carré F, Charron P, Richard P, O’Hanlon R et al (2012) Signifi cance of deep T-wave inversions in asymptomatic athletes with normal cardiovascular examinations: practical solutions for managing the diagnostic conundrum. Br J Sports Med 46(SUPPL. 1):51–58
Migliore F, Zorzi A, Michieli P, Perazzolo Marra M, Siciliano M, Rigato I et al (2012) Prevalence of cardiomyopathy in Italian asymptomatic children with electrocardiographic T-wave inversion at preparticipation screening. Circulation 125(3):529–538
Sharma S, Whyte G, Elliott P, Padula M, Kaushal R, Mahon N et al (1999) Electrocardiographic changes in 1000 highly trained junior elite athletes. Br J Sports Med 33(5):319–324
Pelliccia A, Maron BJ, Culasso F, Di Paolo FM, Spataro A, Biffi A et al (2000) Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation 102(3):278–284
Maron BJ, Pelliccia A (2006) The heart of trained athletes: Cardiac remodeling and the risks of sports, including sudden death. Circulation 114(15):1633–1644
Hoyt WJ, Ardoin KB, Cannon BC, Snyder CS (2015) T-wave reversion in pediatric patients during exercise stress testing. Congenit Heart Dis 10(2):E68-72
Van Der Cammen-Van Zijp MHM, Ijsselstijn H, Takken T, Willemsen SP, Tibboel D, Stam HJ et al (2010) Exercise testing of pre-school children using the Bruce treadmill protocol: new reference values. Eur J Appl Physiol 108(2):393–399
Lee E, Ibrahim ESH, Parwani P, Bhave N, Stojanovska J (2020) Practical guide to evaluating myocardial disease by cardiac MRI. Am J Roentgenol 214(3):546–556
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Gupta, A., Bansal, N., Jour, L.S. et al. Utility of Exercise Stress Testing in Pediatric Patients with T-Wave Inversions. Pediatr Cardiol 43, 713–718 (2022). https://doi.org/10.1007/s00246-021-02776-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-021-02776-x