Persistent T-wave inversion predicts myocardial damage after ST-elevation myocardial infarction

Reindl, Martin; Reinstadler, Sebastian Johannes; Feistritzer, Hans‐Josef; Niess, Lea; Koch, Constantin; Mayr, Agnes; Klug, Gert; Metzler, Bernhard

doi:10.1016/j.ijcard.2017.03.164

Cited by 16 publications

(7 citation statements)

References 37 publications

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“…If the Q waves in a given ECG leads, are due to orientation and direction of the electrical vector, one can speculate that there may not be repolarization abnormalities in those leads. Such Q waves may be more representative of normal anatomic variation than actual pathology while pathologic Q waves may be accompanied by repolarization abnormalities [19]. Our results are consistent with this hypothesis.…”

Section: Discussionsupporting

confidence: 88%

Enhancing the Accuracy of Computerized Interpretation of Old Inferior Wall Myocardial Infarction in a Routine or Preoperative Electrocardiogram by Analyzing Repolarization Abnormalities and Q Waves in Leads II, III and aVF

Zameer¹,

Garcı́a-Dorado²,

Moeen³

et al. 2020

Int J Clin Cardiol

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Introduction: A diagnosis of an old inferior wall myocardial infarction (IMI) by computerized interpretation of a routinely performed electrocardiogram (ECG) may lead to further consultations and imaging studies to confirm or refute that diagnosis. This study was designed to assess the value of abnormal Q waves combined with repolarization abnormalities in inferior leads for the diagnosis of an old IMI as confirmed by imaging studies. Methods: Fifty-six patients, in whom computerized interpretation of the ECG resulted in the diagnosis of old IMI, and in whom imaging studies were also available, were included in this study. ECGs were interpreted using the MUSE-GE system. These ECGs were also analyzed by manually measuring the depth and the width of the Q waves and morphology of ST and T-wave changes in inferior leads. Echocardiograms and nuclear medicine cardiac imaging were performed and interpreted using standard equipment and techniques. Measures of accuracy were calculated and reported with 95% exact binomial confidence intervals (CI). Results: Computerized interpretation of the ECGs leading to the diagnosis of old IMI when compared with IMI confirmed by imaging studies, had a positive predictive value of 52.8% (95% exact CI: 35.5%-69.6%). Adding the manually measured Q waves wider than 40 msec and amplitude of-0.2 mV and repolarization abnormalities in leads II, III and aVF increased the positive predictive value of the test to 86.2% (95% exact CI: 68.3%-96.1%). Conclusions: These results suggest that the computerized interpretation of ECG results in a high rate of false positive readings of old IMI. Presence of diagnostic Q waves in inferior leads, if accompanied by repolarization abnormalities, improves the accuracy of the ECG for the diagnosis of old IMI.

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Section: Discussionsupporting

confidence: 88%

Enhancing the Accuracy of Computerized Interpretation of Old Inferior Wall Myocardial Infarction in a Routine or Preoperative Electrocardiogram by Analyzing Repolarization Abnormalities and Q Waves in Leads II, III and aVF

Zameer¹,

Garcı́a-Dorado²,

Moeen³

et al. 2020

Int J Clin Cardiol

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“…After myocardial infarction, T‐wave inversions often accompany pathological Q waves, but they may also appear in isolation. The location of the postischemic T‐wave inversions within the 12‐lead ECG usually reflects the site of the ischemia during the acute phase (Luna et al., 2014), and persistent T‐wave inversions after ST‐elevation myocardial infarction have been associated with worse prognosis and larger infarct size (Lancellotti et al, 2002; Reindl et al., 2017). In our study, in participants with known CHD at baseline, T‐wave inversions did not seem to associate significantly with mortality.…”

Section: Discussionmentioning

confidence: 99%

The prognostic significance of T‐wave inversion according to ECG lead group during long‐term follow‐up in the general population

Istolahti

Lyytikäinen

Huhtala

et al. 2020

Noninvasive Electrocardiol

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Background Inverted T waves in the electrocardiogram (ECG) have been associated with coronary heart disease (CHD) and mortality. The pathophysiology and prognostic significance of T‐wave inversion may differ between different anatomical lead groups, but scientific data related to this issue is scarce. Methods A representative sample of Finnish subjects (n = 6,354) aged over 30 years underwent a health examination including a 12‐lead ECG in the Health 2000 survey. ECGs with T‐wave inversions were divided into three anatomical lead groups (anterior, lateral, and inferior) and were compared to ECGs with no pathological T‐wave inversions in multivariable‐adjusted Fine–Gray and Cox regression hazard models using CHD and mortality as endpoints. Results The follow‐up for both CHD and mortality lasted approximately fifteen years (median value with interquartile ranges between 14.9 and 15.3). In multivariate‐adjusted models, anterior and lateral (but not inferior) T‐wave inversions associated with increased risk of CHD (HR: 2.37 [95% confidence interval 1.20–4.68] and 1.65 [1.27–2.15], respectively). In multivariable analyses, only lateral T‐wave inversions associated with increased risk of mortality in the entire study population (HR 1.51 [1.26–1.81]) as well as among individuals with no CHD at baseline (HR 1.59 [1.29–1.96]). Conclusions The prognostic information of inverted T waves differs between anatomical lead groups. T‐wave inversion in the anterior and lateral lead groups is independently associated with the risk of CHD, and lateral T‐wave inversion is also associated with increased risk of mortality. Inverted T wave in the inferior lead group proved to be a benign phenomenon.

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“…In their study, they concluded PTI after STEMI was related to greater myocardial damage on CMR. PTI adds predictive value beyond pathological Q-wave [12]. On a 04-month study follow up of 103 patients were found to have present T wave inversions (PTI), among which 65% of culprit lesions of right coronary artery patients had PTI, whilst 87% PTI was in left anterior descending artery (LAD) patients which were displayed in lead V3, V4, V2, and aVL.…”

Section: Discussionmentioning

confidence: 99%

Absence of New T-wave Inversion After Successful Primary Percutaneous Coronary Intervention

Jamil

Ahmed

et al. 2022

Preprint

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BACKGROUNDNew beginning of T Wave Inversion (TWI) after the primary PCI was taken as no negative T waves on the presenting ECG and considered as a new TWI case. Major Adverse Cardiac Events (MACE) which included occurrence of nonfatal myocardial infarction, cardiovascular mortality, and re-hospitalization for heart failure was taken as primary endpointThe primary aim of the study was to determine the frequency of absence of new T wave inversion (TWI) after successful Primary Percutaneous Coronary Intervention (PPCI) in patients. The secondary aim of the study was to assess the association between the development of new TWI after successful PCI and MACE after 30-days of the procedure.METHOD This 06 months prospective observational study was conducted at the Department of Interventional Cardiology at the National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan.Non-probability, Consecutive Sampling was used to collect the study sample. All patients aged between 18 to 65 years, both male and female, who presented with acute STEMI (within 12 hours of chest pain) and underwent successful primary PCI were included in this study. RESULTSA total of 310 patients were enrolled with no missing data and incomplete information was found. Out of 310, most of the study population was male (237) as compared to female (73). Non-Diabetic, Non-hypertensive, Non-Smoker, Non-Obese, and with no Family History were not statistically significant with new TWI after 30 min and 48 hrs successful PCI in acute STEMI patients. MACE after 30 days was observed to be a not statistically significant factor as well with respective with new TWI after 30 min and 48 hrs successful PCI in acute STEMI patients, however, all patients were observed to be free from MACE after 30 daysCONCLUSION Overall in our study population, we have observed new TWI frequently observed in all age groups with gender distribution and comorbid factors. Although our primary objective was straightly observed in the minimal population as absence of T wave frequency observed to be minimal.

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Persistent T-wave inversion predicts myocardial damage after ST-elevation myocardial infarction

Cited by 16 publications

References 37 publications

Enhancing the Accuracy of Computerized Interpretation of Old Inferior Wall Myocardial Infarction in a Routine or Preoperative Electrocardiogram by Analyzing Repolarization Abnormalities and Q Waves in Leads II, III and aVF

Enhancing the Accuracy of Computerized Interpretation of Old Inferior Wall Myocardial Infarction in a Routine or Preoperative Electrocardiogram by Analyzing Repolarization Abnormalities and Q Waves in Leads II, III and aVF

The prognostic significance of T‐wave inversion according to ECG lead group during long‐term follow‐up in the general population

Absence of New T-wave Inversion After Successful Primary Percutaneous Coronary Intervention

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