Maria J. Brosnan et al. JACEP 2015;1:84-91

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Maria J. Brosnan et al. JACEP 2015;1:84-91 Lateral Cardiac Displacement, but Not RV Volumes Explain Right Precordial T-Wave Inversion (A) Horizontal long-axis CMRI images of 2 endurance athletes, athlete A (left) and athlete B (right). Although both athletes had almost identical cardiac volumes, athlete A demonstrated less lateral displacement of the RV than athlete B (%LatD = 36.7 vs. 59.7%, respectively). The resultant ECG appearances are shown in B. (B) Precordial ECG leads V1 to V6 have been transposed onto the CMRI images of athletes A and B in approximate standard positions. The corresponding appearances of leads V1 to V6 of the athletes’ ECGs are shown at the bottom right of each image. In the athlete A, the body of the right ventricle overlies the sternum, between V1 and V2 (mid-RV axis). T-wave inversion is seen in lead V1 but not in V2 or V3. In athlete B, the body of the right ventricle is displaced laterally, lying to the left of the sternum at the position of lead V3, and the RV apex (apical axis) is displaced laterally toward lead V5. T-wave inversion is seen in leads V1 and V2. Also note the bifid appearance of lead V4. %LatD = lateral displacement of the RV apex (L1/L2%); CMRI = cardiac magnetic resonance imaging; ECG = electrocardiography; L1 = distance from sternum to RV apex; L2 = distance from sternum to left axilla; LVEDV = left ventricular end-diastolic volume; RVEDV = right ventricular end-diastolic volume. Maria J. Brosnan et al. JACEP 2015;1:84-91 American College of Cardiology Foundation