Background: T wave inversion on an electrocardiogram (ECG) is suspicious of cardiac disease, yet normal pediatric patients with this abnormality have been identified. The purpose of this study is to evaluate the T wave response of patients with normal hearts and T wave inversion on baseline ECG during exercise stress testing (EST). Methods:IRB approved retrospective review of the EST database was performed. Inclusion criteria included a normal heart and age > 18. Data included: baseline ECG, peak heart rates and METS achieved, and heart rates at which T waves “normalized” during EST. All were exercised using Modified Bruce Protocol with continuous monitoring of ECG’s.Results: Thirteen patients met inclusion criteria (8 males/5 females). Race included Caucasian (6), African American (6), and Hispanic (1). Median age was 15.5 years (range 8 -18). Eleven patients (85%) experienced complete T wave reversion (normalization) and 2 (15%) experienced partial (3/6 limb leads) reversion during EST. Mean peak heart rate was 192 beats per minute (bpm)(range 169-214) and mean maximum METS achieved was 13.2 (range 9-18.5). The median heart rate at which T wave normalization was 153 bpm(range 113-187)and median METS was 4.5(range 1-12.3).
Conclusion: Exercise Stress Testing patients with normal hearts with T wave inversion on resting ECG may result in complete reversion or normalization of their T waves. This phenomenon occurs in all sexes and ethnicities encountered. A larger study is needed to improve the power and garner long-term follow up information.