Negative T Wave in Ischemic Heart Disease: A Consensus Article

Abstract

Background: For many years was considered that negative T wave in ischemic heart disease represents ischemia and for many authors located in subepicardial area.Methods: We performed a review based in the literature and in the experience of the authors commenting the real significance of the presence of negative T wave in patients with ischemic heart disease.Results: The negative T wave may be of primary or secondary type. Negative T wave observed in ischemic heart disease are of primary origin, therefore not a consequence of abnormal repolarization pattern. The negative T wave of ischemic origin presents the following characteristics: (1) are symmetrical and of variable deepness; (2) present mirror patterns; (3) starts in the second part of repolarization; and (4) may be accompanied by positive or negative U wave. The negative T wave of ischemic origin may be seen in the following clinical settings: (1) postmyocardial infarction due to a window effect of necrotic zone and (2) as a consequence of reperfusion in case of aborted MI when the artery has opened spontaneously, or after fibrinolysis, PCI, or coronary spasm.Conclusion: Acute ongoing ischemia do not cause negative T wave. This pattern appears when the ongoing ischemia is vanishing or in the chronic phase. In all these cases the cause of negative T wave is not located in the subepicardial area. Furthermore, positive exercise testing is expressed by ST depression never by isolated negative T wave. There are many circumstances that may present negative T wave outside ischemic heart disease and that have been discussed in this paper.

Prognostic value of positive T wave in lead aVR in patients with non‐ST segment myocardial infarction

“…T wave, which represents the repolarization of ventricles, can be inverted due to disruption of normal physiologic repolarization of TA B L E 2 Comparison of patients with and those without a positive T wave in lead aVR regarding coronary angiography results and outcomes cardiac myocytes. Inversion of T wave in lead aVR manifests as a positive T wave (Dilaveris, Antoniou, Gatzoulis, & Tousoulis, 2017;de Luna et al, 2014). ST segment elevation in lead aVR may occur as a result of global subendomyocardial ischemia, which can be caused by 3VD/LMCA stenosis (Tamura, 2014).…”

The Value of Electrocardiographic Abnormalities in the Prognosis of Pulmonary Embolism: A Consensus Paper

“…The pathophysiology of T-wave changes in the precordial leads is not well established, but is thought to be the consequence of an ischemic phenomenon due to low cardiac output in the context of RV dilation and strain. 15,37,58 Presence of TWI in anterior leads has been reported with variable frequency from 16% to 68%. 21,50 This ECG abnormality makes up a significant component of the 21point ECG score by Daniel et al with up to 15 points being assigned based on presence and depth of TWI in leads V 1 -V 3 .…”

Electrocardiographic Predictors of Cardiovascular Mortality

“…According to a recent consensus article, negative T waves are not caused by acute ischemia but appear in chronic or vanishing ischemia, and the negative ischemic T waves are symmetrical, of variable deepness, presenting mirror patterns, and may be accompanied by positive or negative U waves [ 54 ]. Myocardial edema rather than systolic dysfunction underlies the Wellens' ECG pattern (negative T wave and prolonged QT interval regardless of the causative mechanism) in patients with stunned myocardium [ 55 ] and T wave inversion and QT interval prolongation and life-threatening arrhythmias in patients with Takotsubo cardiomyopathy [ 56 ].…”