Upright T Wave in Lead V1 as an Important Predictor of Significant Coronary Artery Disease in Patients with Chest Pain

Abstract

Background: Cardiovascular disease is a worldwide great burden on the health care syste early diagnosis and treatment of CAD can reduce the mortality and morbidity. We aimed to determine the association between upright T wave in lead V1 and coronary artery disease (CAD) in patients who presented with chest pain or positive non-invasive tests in emergency department. Methods: In this retrospective cross sectional design we reviewed the clinical and coronary angiography data of patients who had normal ECG. Presence of coronary artery disease was compared between patients with and without upright T waves in V1. Results: Data of 100 patients with upright T wave more than 1.5 mm in V1 was compared with 100 patients with completely normal ECG. Male patients with coronary artery disease (CAD) were dominant in upright T wave group. However, other traditional cardiovascular risk factors were not statistically different between groups. Based on the multivariate logistic regression model and after adjustment for confounding factors (i.e. gender, dyslipidemia and smoking), presence of upright T wave in the V1 and male gender were still associated with greater risk of coronary artery disease, Odds ratio 4.6 CI 95% (3.1 -6.3) and 3.4 CI 95% (2.2 -4.8), respectively. Conclusions: In patients with chest pain and unremarkable ECG, presence of upright T wave in lead V1, is an early diagnostic tool for CAD. Male patients with chest pain and upright T wave in lead V1 probably have significant CAD.

Implications of Localized ST Depression in a Vascular Territory and Altered Precordial T-Wave Balance in Ischemic Heart Disease

“…The absence of normal precordial T-wave balance is one of the subtle signs of significant CAD (coronary artery stenosis >50%) in ECG. Studies have shown that the loss of precordial T-wave balance (T1 > T6), T-wave in V1 > 1.5 mm, and upright T-wave in V1 have been associated with significant CAD [12][13][14][15][16]. The reason for this is unclear and needs further research.…”

“…Amirzadegan et al [15] Upright T-wave in V1 > 1.5 mm had OR = 2.38 (1.78 -3.12) for coronary artery stenosis of greater than 50%.…”

The relationship between demographic features, anthropometric parameters, sleep hours, and physical activity and ECG parameters in Fasa Persian cohort study

“…Less than 50% of people with Myocardial Infarction (MI) showed ST-wave changes in their initial ECG (13). T-wave changes were also shown to be associated with myocardial ischemia, and T-wave inversion was an important indicative of this disease (14). Furthermore, ECG abnormalities were associated with an increased risk of adverse cardiac events, including hypertrophic cardiomyopathy (15), fast heartbeat, prolonged PR interval and QT inversion, and abnormal changes in ECG axes (16).…”