Serial changes in negative T wave on electrocardiogram in acute pulmonary thromboembolism

Prognostic Significance of Inverted T Waves in Patients With Acute Pulmonary Embolism

“…9 We analyzed the following ECG findings previously shown to be associated with PE: (1) arrhythmias; (2) pulmonary P: P waves ≥2.5 mm in limb leads or ≥1.5 mm in lead V1; (3) right axis deviation: QRS electrical axis >90°; (4) left axis deviation: QRS electrical axis ≤-30°; (5) complete right bundle block: QRS intervals ≥0.12 s; (6) incomplete right bundle block: QRS intervals = 0.10-0.11 s; (7) S1S2S3: the presence of S waves of at least 1.5 mm amplitude in leads I, II and III; (8) S1Q3T3: the presence of S waves in lead I and Q waves in lead III, each having amplitudes of ≥1.5 mm, in association with negative T waves in lead III; (9) low voltage: greatest overall deflection of the QRS complex ≤5 mm in all limb leads; (10) right ventricular hypertrophy: the presence of R waves >5 mm or an R/S ratio of ≥1 in lead V1; (11) clockwise rotation: a shift in the transition zone (R = S) in the precordial leads to V5 or beyond; (12) ST elevation: elevation of ST segments ≥1.0 mm in any lead except lead aVR; and (13) ST depression: depression of ST segments ≥0.5 mm in any lead in the absence of complete bundle branch block or ventricular hypertrophy. [9][10][11][12][13][14][15][16][17][18] Echocardiographic Evaluation Right ventricular function was assessed using transthoracic echocardiography. Right ventricular dysfunction was diagnosed if patients had any of the following findings: (1) abnormal motion of the interventricular septum; (2) dilation of the right ventricle (diastolic diameter ≥30 mm); (3) hypokinesis of the right ventricle; or (4) tricuspid valve regurgitation (jet velocity >2.5 m/s).…”

“…[9][10][11][12][13][14][15][16][17][18] Inverted T waves are frequently observed in lead III and precordial leads in patients with acute PE. 9,11,14,15,17 Some, 9,15,16 but not all, studies have shown that inverted T waves are related to the severity of acute PE. 17,18 Previous studies assessing the clinical significance of inverted T waves in patients with acute PE have focused mainly on the presence or absence of this finding; however, the relationship between the extent of inverted T waves and the severity of acute PE remains unclear.…”

Significance of ST-segment deviation in patients with acute pulmonary embolism and negative T waves

“…However, another study [17] suggested that an increase in the amplitude of NTW in the precordial leads after thrombolytic therapy reflects an improvement in cardiopulmonary hemodynamics with concomitant decrease of both RV diameter and mean pulmonary artery pressure. We previously described the dynamic ECG changes in 2 patients and found that NTW developed later than STE and that the NTW persisted beyond recovery of RVD [14].…”

“…More leads with NTW are also related to worse short-term prognosis [18,19]. However, there is a poor relationship in patients after effective treatment where the RVD has possibly been recovered [14,17].…”

Usefulness of Decreasing Number of Negative T Wave Leads on Electrocardiography for Predicting the Improvement of Pulmonary Hypertension

“…Stein et al suggested the magnitude of the T wave inversion was not related to hemodynamic abnormality and severity of pulmonary embolism 3) . Yoshinaga et al reported that there was no correlation between the peak negative amplitude of T wave and pulmonary artery pressure 4) . On the other hand, Kosuge et al…”