American track and field star Joyner, the famous American female volleyball player Hyman, Spanish soccer players Puerta, Halk, Chinese men’s volleyball original main Zhu Gang, more and more athletes have fallen on the sports field. And there are statistics that 82% of sudden deaths are caused by cardiac diseases. So, what we need to do is to find some traces of the athletes who “never found any physical abnormality” as much as possible before the death comes. For athletes, intense physical training is necessary, and in the long run, the athlete’s cardiac electrophysiology and myocardium will be physiologically adapted to change, thus giving birth to an “athlete’s heart”. However, in healthy athletes, the phenomenon of pathological T-wave inversion (PTWI) rarely occurs on an ECG. All ECG reading guidelines specifically for athletes show that we cannot consider PTWI as a physiological adaptation (unless it is present in leads aVR, III and V1, or if the patient is a black athlete from the Caribbean with preexisting symptoms and PTWI is present in leads V1-V4 after a domed ST segment). For this reason, Dr. François Carré and colleagues from the Hospital Pontchaillou in France conducted a study to investigate the correlation between the presence of PTWI and cardiac rationale changes in athletes and the need for further cardiac magnetic resonance (CMR) examinations. The article was published in the journal Circulation in November 2014. The study included 155 athletes who showed PTWI on ECG and further ECG, echocardiography, exercise testing, 24h ambulatory ECG and CMR in clinical practice. The results showed that 44.5% of the athletes had definite cardiac disease, including hypertrophic cardiomyopathy in 81%. Echocardiography identified abnormalities in 7.2% of positive cases, while CMR confirmed the diagnosis of cardiac disease in 24 more athletes on top of this. The presence of PTWI in patients with a family history of sudden sudden cardiac death (SCD) and ST-segment depression predicted a higher risk of cardiac disease. In addition, there were five patients who had no abnormal initial findings on admission and successively developed pathological symptoms during follow-up. In conclusion, 45% of the athletes who had a PTWI on examination showed cardiac pathological changes, so once an athlete has a PTWI on ECG, even if the echocardiographic findings are normal, the physician should treat it as a pathological finding until the diagnosis is confirmed and should include CMR as a routine test. Moreover, it is necessary to recommend suspension from participation in competitive sports and long-term follow-up for this suspicious patient population.