Case report

A 17-years-old white male patient with no personal history of interest and asymptomatic from the cardiovascular point of view, but with a family history of paternal grandfather with dilated cardiomyopathy and mild depressed left ventricle ejection fraction (LVEF) who died at 83 years of age of a noncardiological cause. In an electrocardiogram (ECG) performed during a sports examination (field hockey player), T-wave inversion (TWI) was identified in the inferior leads (Fig. 1). For further evaluation, an echocardiogram was performed, showing a pattern of hypertrabeculation in the inferior, lateral, and apical walls of the left ventricular, which was confirmed by cardiac magnetic resonance imaging (Fig. 2A and 2B), fulfilling the criteria for noncompaction, with no other notable findings. As a result of these findings, the 57-year-old boy’s father, who was asymptomatic cardio-vascular and had a non-pathological ECG, was also evaluated and showed noncompaction cardiomyopathy with normal LVEF.

Figure 1 Electrocardiogram showing T-wave inversion in the inferior leads. 

Figure 2 Cardiac magnetic resonance imaging. 2A: 4, 2 and 3 chamber axis; 2B: short axis of the left ventricular (LV) from basal to apical segments) showing a non-compactation pattern in the inferior, lateral and apical walls of the LV. 

Discussion

TWI in large populations of mostly white athletes is present at around 2-3%, with similar prevalence among athletes and sedentary controls, but with a higher prevalence in women and black athletes, without implying the presence of an underlying cardiomyopathy¹-⁵. In non-black athletes, TWI ≥ 1 mm in leads other than III, aVR, and V1-V2, should lead to further evaluation¹,². Instead, in black or high-intensity athletes, TWI after ST-segment elevation in V2-V4 does not need further investigation, whereas inferior or lateral lead TWI, or TWI in V2-V4 not preceded by ST-segment elevation, warrants follow-up if the initial cardiostructural study is norma⁴,⁵. It is essential to keep these aspects in mind to avoid under-diagnosing cardiostructural pathology in young athletes.