In Reply We thank Drs Gati, Merghani, and Sharma for their interest in our discussion about the challenges of left ventricular hypertrabeculation in athletes.1 Like many rare diseases, the diagnostic criteria for left ventricular noncompaction (LVNC) are derived from small cohorts, which inherently lead to poor specificity. Given the low prevalence of this disease, a long-term registry is likely needed before diagnostic criteria with high specificity can be produced. Our understanding of incidental T-wave inversions on ECG is evolving. In the precordial leads, T-wave inversions could be a manifestation of arrhythmogenic right ventricular cardiomyopathy (ARVC). T-wave inversion and reduced systolic function appear useful as part of the diagnostic criteria for LVNC as well.2 Of note, a recent paper by Brosnan et al3 describes T-wave inversions in healthy endurance athletes recorded in leads V2-3. They hypothesized that this is likely secondary to displacement of the RV toward the axilla rather than RV dilation or hypertrophy and therefore unlikely to be pathologic.3
Peritz DC, Chung EH. Increased Left Ventricular Trabeculation Does Not Necessarily Equate to Left Ventricular Noncompaction in Athletes. JAMA Intern Med. 2015;175(7):1247. doi:10.1001/jamainternmed.2015.3109
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