The presence of T wave inversion on screening electrocardiogram may represent an early sign of cardiomyopathies in athletes. This finding even in very young athletes can generate some suspicion and may determine a contraindication to practice competitive sport. The aim of this study is to evaluate the prevalence of T wave inversion in a population of young competitive athletes and determine whether they can be associated with the occurrence of cardiomyopathies in the absence of other pathological features.

A prospective cross-sectional study was carried out and 581 subjects were screened for competitive sport eligibility. Based on inclusion/exclusion criteria, 53 athletes showed T wave inversion and they were selected to undergo further investigations.

In 32,1% of cases, we have identified the cause of T wave inversions and we suspended them from competition. In particular, in 15% of athletes who showed T wave inversions, we found cardiomyopathies.

Prevalence of T wave inversion in this population of athletes was 9,1%. At the end of second and third-level evaluations, eight athletes with T wave inversion showed an early form of cardiomyopathy and were suspended from competitive sport. Most of them showed T wave inversion in infero-lateral leads on electrocardiogram.

The probability that competitive athletes have a concealed cardiomyopathy is low, but not negligible. Pre-participation screening for competitive sport activity represents an excellent opportunity to early identify cardiomyopathies and other pathologies that increase the risk of sudden death in apparently healthy young athletes.