"Nonspecific" ST and T-Wave Changes

Friedberg, Charles K.; Zager, Albert

doi:10.1161/01.cir.23.5.655

Cited by 34 publications

(8 citation statements)

References 6 publications

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“…In our data, overall repolarization complexity is higher (22% vs. 11%), compared to other general populations, perhaps because nearly 65% of our sample have some degree of cardiovascular disease. This is expected given that other physiological (eg, CAD) and psychological (eg, depression) factors besides ischemia can induce nonspecific STT changes . However, despite the nonspecific repolarization changes observed in our sample at baseline, myocardial ischemia resulted in clear increases in T‐wave complexity ratio between groups for more than 60 minutes, confirming that ischemia‐induced changes in repolarization complexity are significantly greater than other nonspecific factors in the context of chest pain.…”

Section: Discussionsupporting

confidence: 65%

Clinical Utility of Ventricular Repolarization Dispersion for Real‐Time Detection of Non‐ST Elevation Myocardial Infarction in Emergency Departments

Al‐Zaiti

Callaway

Kozik

et al. 2015

JAHA

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BackgroundA specific electrocardiographic (ECG) marker of ischemia would greatly improve the speed and accuracy of detecting and treating non-ST elevation myocardial infarction (NSTEMI). We hypothesize that ischemia induces ventricular repolarization dispersion (VRD), altering the T-wave before any ST segment deviation. We sought to evaluate the clinical utility of VRD to (1) detect NSTEMI cases in the emergency department (ED) and (2) identify NSTEMI cases at high risk for in-hospital major adverse cardiac events (MACEs).Methods and ResultsWe continuously recorded 12-lead Holter ECGs from chest pain patients upon their arrival to the ED. VRD was quantified using principal component analysis of the 12-lead ECG to compute a T-wave complexity ratio (ie, ratio of second to first eigenvectors of repolarization). Clinical outcomes were obtained from hospital records. The sample was composed mainly of older males (n=369; ages 63±12 years; 63% males), and 92 (25%) had NSTEMI and 26 (7%) had MACEs. Baseline T-wave complexity ratio modestly correlated with peak troponin levels (r=0.41; P<0.001) and was a good classifier of NSTEMI events (area under the curve=0.70). An increased T-wave complexity ratio on the presenting ECG was strongly associated with NSTEMI (odds ratio [OR]=3.8 [2.1 to 5.8]) and in-hospital MACE (OR=8.2 [3.1 to 21.5]).ConclusionsA simple measure of global VRD on the presenting 12-lead ECG correlates with ischemic myocardial injury and can discriminate NSTEMI cases very early during evaluation. Prospective studies should validate these findings and test whether VRD can guide therapy.

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Section: Discussionsupporting

confidence: 65%

Clinical Utility of Ventricular Repolarization Dispersion for Real‐Time Detection of Non‐ST Elevation Myocardial Infarction in Emergency Departments

Al‐Zaiti

Callaway

Kozik

et al. 2015

JAHA

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“…Simultaneous other ECG abnormalities were much more common when a negative T‐wave was present, but limited to ST‐segment/junction depression, most frequently, and also Q/QS pattern. The former would be expected since nondiagnostic ST/T changes are the most common ECG changes overall 30 . Also conditions causing ECG changes often concomitantly affect ST‐junction/segment levels and T‐wave axis.…”

Section: Discussionmentioning

confidence: 99%

“…The former would be expected since nondiagnostic ST/T changes are the most common ECG changes overall. 30 Also conditions causing ECG changes often concomitantly affect ST-junction/segment levels and T-wave axis. Thus, we found ST-segment/junction depression almost 14 times more common when a negative T-wave was present.…”

Section: Factors That May Affect Prediction Of Death By a Negative mentioning

confidence: 99%

A negative T‐wave in electrocardiogram at 50 years predicted lifetime mortality in a random population‐based cohort

Sjöland

Caidahl

et al. 2020

Clinical Cardiology

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Background: Severe electrocardiographic (ECG) abnormalities in asymptomatic subjects correlate with cardiovascular risk. Hypothesis: The role of minor ECG abnormalities is less well-known. We evaluated the association between a negative T-wave and mortality, as a possible marker for prognosis. Methods: A prospective, population-based cohort, examined at 50 years, and followed until death. Time to death (event rates) and predictive role of a negative Twave (Cox regression) were analyzed. Results: Participants (n = 839) with a negative T-wave (7.3%) had significantly higher blood pressure (BP) (mean systolic 157.9 mmHg vs 136.

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“…In order to obtain accurate data in ST segment, monitoring the assurance of the locations of the electrodes from removal is important [16][17][18][19]. The baseline must be stable and not wandering.…”

Section: Discussionmentioning

confidence: 99%

Non Specific S-T Segment Variations during Intravenous Induction in Anesthesia in Hypertensive Patients Treated with Renin Angiotensin System Antagonists

2017

JACCOA

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Background: induction in anesthesia and airway's manipulations are stressful events for patients undergoing surgery, producing consecutive changes in blood pressure and pulse rate. There are several reports indicating that hypertensive patients treated with Renin angiotensin system (RAS) antagonists show greater hemodynamic changes during these periods which may imply that coronary circulation is compromised and variations in the ST-T segment might be noticed. The aim of this study was to evaluate and report the ST changes appeared during intravenous induction to anesthesia in hypertensive patients. Method and material:In prospective, randomized clinical study, Sixty patients undergoing elective surgery in general anesthesia, ASA I and II, BMI <30 m 2 were randomized into two groups: Group A included hypertensive patients, chronically treated with RAS antagonists (n=30) and Group B, included normotensive patients (n=30). Patients in both groups underwent standardized anesthesia induction protocol. In both groups we analyzed the changes of blood pressure, heart rate and non-specific ST changes (smaller than 0.1 mm) at five times: T0 (ambulatory report); T1 -pre induction; T2 -after induction; T3 (at laryngoscopy), T4 (5 min after intubation) and T5 10 min after intubation. Results:The size of the ST segment at T0 was evidently different in both groups (-0.21mm+0.4 vs. -0.01mm+0.2) but statistically insignificant (p>0.05). At T3 (during the laryngoscopy) there was no differences in the size of the ST segment between the study groups (p=0.07). The main changes were found at T4: -0.31±0.4 vs. -0.02±0.3 (p=0.004427), 5 minutes after the intubation. It seems that this is a result of the stress reaction of the body on the laryngoscopy and due to the effects of the released catecholamines. Conclusion:The laryngoscopy and the intubation of the hypertensive patients treated with RAS antagonists provoke a remarkable decrease of the BP that is responsible for a coronary vasoconstriction and changes in the size of the ST segment. The main changes in the ST segment are 5 minutes after the intubation.

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"Nonspecific" ST and T-Wave Changes

Cited by 34 publications

References 6 publications

Clinical Utility of Ventricular Repolarization Dispersion for Real‐Time Detection of Non‐ST Elevation Myocardial Infarction in Emergency Departments

Clinical Utility of Ventricular Repolarization Dispersion for Real‐Time Detection of Non‐ST Elevation Myocardial Infarction in Emergency Departments

A negative T‐wave in electrocardiogram at 50 years predicted lifetime mortality in a random population‐based cohort

Non Specific S-T Segment Variations during Intravenous Induction in Anesthesia in Hypertensive Patients Treated with Renin Angiotensin System Antagonists

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