Prevalence and significance of anterior T-wave inversion in elite football players in the United Kingdom

Yamagata, K, Castelletti, S, Yeo, TJ, Finocchiaro, G, Marwaha, S, Bhatia, RT, Augustine, D, Bowes, M, Clift, P, Cooper, RM ORCID: 0000-0001-7482-828X, Kenny, A, Keteepe-Arachi, T, Oxborough, D ORCID: 0000-0002-1334-3286, Patel, K, Rakhit, D, Ripley, D, Ramcharan, T, Stebbings, GK, Varnava, AM, Walsh, J et al (2026) Prevalence and significance of anterior T-wave inversion in elite football players in the United Kingdom. British Journal of Sports Medicine. ISSN 0306-3674

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Abstract

OBJECTIVE: The "athlete anterior repolarisation pattern", characterised by J-point elevation with ascending convex ST-segments and anterior T-wave inversion (ATWI) confined to leads V1-V4, has been considered a normal finding in athletes of Black ethnicity (African-Caribbean descent). This repolarisation pattern was considered to potentially represent an underlying cardiomyopathy in non-Black athletes although recent studies have challenged this. We assessed the prevalence and significance of ATWI among professional Black and non-Black football players in the UK. METHODS: Athletes underwent pre-participation screening (2017-2024), including a health questionnaire, a 12-lead ECG and an echocardiogram. ATWI was defined as TWI confined to leads V1 to V3 or V4. Ethnicity was categorised as Black or non-Black. RESULTS: 10 955 athletes were studied, comprising 9009 (82.2%) males and 1946 (17.8%) females. 2372 (21.7%) athletes were of Black ethnicity and 8583 (78.3%) were non-Black. Black athletes were marginally younger (18.3±3.8 vs 19.2±4.7 years; p<0.001). ATWI was observed in 255 (10.8%) Black athletes versus 115 (1.3%) non-Black athletes (p<0.001). ATWI was more common in Black males compared with females (251 (11.0%) vs 4 (4.3%); p=0.04). Among non-Black athletes, ATWI was less common in males (81 (1.2%) males vs 34 (1.8%) females; p=0.04). The "athlete anterior repolarisation pattern" was present in 245 (10.3%) Black athletes and 42 (0.5%) non-Black athletes (p<0.001). None of the Black athletes with ATWI exhibited major cardiac pathology, whereas one (0.9%) non-Black athlete with ATWI and isoelectric ST-segments was diagnosed with arrhythmogenic cardiomyopathy. CONCLUSION: The "athlete anterior repolarisation pattern" was 20 times more common in Black athletes than in non-Black athletes. However, this repolarisation pattern was not associated with major pathology in either Black or non-Black athletes in this UK screening cohort. By contrast, the only cardiomyopathy identified in an athlete with any ATWI occurred in a non-Black athlete with isoelectric ST-segments extending to V4.

Item Type:	Article
Uncontrolled Keywords:	Cardiology; Sports medicine; Heart disease; Cardiovascular Diseases; Cardiology; Cardiovascular Diseases; Heart disease; Sports medicine; 32 Biomedical and Clinical Sciences; 3202 Clinical Sciences; 42 Health Sciences; Cardiovascular; 4.2 Evaluation of markers and technologies; 09 Engineering; 11 Medical and Health Sciences; 13 Education; Sport Sciences; 3202 Clinical sciences; 4207 Sports science and exercise; 5201 Applied and developmental psychology
Subjects:	G Geography. Anthropology. Recreation > GV Recreation Leisure > GV561 Sports
Divisions:	Astrophysics Research Institute
Publisher:	BMJ
Date of acceptance:	29 August 2026
Date of first compliant Open Access:	29 October 2026
Date Deposited:	29 Oct 2026 15:14
Last Modified:	29 Oct 2026 15:14
DOI or ID number:	10.1136/bjsports-2026-112060
URI:	https://researchonline.ljmu.ac.uk/id/eprint/29768

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