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Anterior T-wave inversion (aTWI) can be a common electrical sign in cardiomyopathies but also a benign feature regressing with age in healthy children. Unfortunately, little is known about the age of positivization of aTWI and its determinants in children and longitudinal data are not available. The aim of this longitudinal study was to identify the age and determinants of positivization of aTWI in healthy children. ATWI was observed in 331 healthy children. They were evaluated yearly until positivization for a maximum period of 4 years. Positivization of aTWI was observed in 312 children (94%). The weight, height/length and their respective percentiles at birth and at the time of positivization of aTWI and weeks of gestation at birth were collected. Positivization of aTWI occurred at a mean age of 13.0±2.0 years. When aTWI became positive, most children had a height between 51° and 75° or over the 75° percentile. At the multivariate logistic regression analysis height, weight, percentiles of height and weight at the time of positivization were identified as the strongest independent predictors of the positivization of aTWI. No correlation was found for prematurity and anthropometrics characteristics at birth. ATWI is a common feature of pediatric ECG, usually regressing with age. Height, weight, percentiles of height and weight at the time of positivization were identified as determinants of TWI positivization. These simple anthropometric characteristics should be used in addition to chronological age in order to interpret aTWI in children.


Francesca Anselmi, Nicola Cangiano, Chiara Fusi, Beatrice Berti, Andrea Franchini, Marta Focardi, Matteo Cameli, Massimo Capitani, Marco Bonifazi, Sergio Mondillo, Flavio D'Ascenzi. The determinants of positivization of anterior T-wave inversion in children. The Journal of sports medicine and physical fitness. 2021 Nov;61(11):1548-1554

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PMID: 33305549

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