T wave abnormalities identify patients with previous lateral wall myocardial infarction and circumflex artery disease

• We studied 166 patients with known or suspected ischemic heart disease.
• Patients with secondary repolarization abnormalities were excluded.
• Indices based on a in T wave amplitude in leads 1, V2 and V6 were generated.
• These indices identified a previous lateral infarction at myocardial scintigraphy.
• These indices accurately identified a left circumflex artery occlusion at angiography.

BackgroundThe diagnosis of previous lateral myocardial infarction is based on QRS morphology.ObjectivesTo explore the diagnostic role of T wave abnormalities.MethodsWe studied 166 patients with known or suspected ischemic heart disease who underwent a 12-lead electrocardiogram, myocardial perfusion scintigraphy, and coronary arteriography within 90 days. We excluded patients with bundle-branch block, hypertrophy, or paced rhythm.ResultsOnly one patient had a prominent R wave in V1, no patient showed lateral Q waves of necrosis. T wave amplitude in V2–V6 ≥ 0.6 mV, and T wave amplitude in lead 1 + V6 ≤ 0 mV detected a lateral infarction (sensitivity 33 and 44%, specificity 83 and 80%). T wave amplitude in lead 1 + V6 ≤ 0 mV was the only independent predictor of infarction or LCx occlusion (AUC 0.72 and 0.74). Serum potassium values were not associated with T wave abnormalities.ConclusionT wave abnormalities identify previous lateral infarction and LCx disease.

We studied 166 patients with known or suspected ischemic heart disease who underwent a 12-lead electrocardiogram, rest myocardial perfusion scintigraphy, and coronary arteriography within 90 days.A reduction in T wave amplitude in leads 1 and V6 and an increase in T wave amplitude in V2 were consistently associated with a previous infarction of the left ventricular lateral free wall, as well as with left circumflex occlusion.In this patient with previous lateral infarction, the T wave is tall in V2 (1.2 mV), negative in V6 (− 0.2 mV) and mildly positive in lead 1 (0.1 mV).The T2 − T6 index (T wave amplitude in V2 minus its amplitude in V6) is 1.4 mV and the TL1 + T6 index (T wave amplitude in lead 1 plus its amplitude in V6) is − 1 mVEven in the absence of lateral Q waves of necrosis and of a prominent R wave in the anterior leads, this ECG indicates a previous lateral infarction and a left circumflex coronary occlusion with a specificity > 90%.Figure optionsDownload high-quality image (517 K)Download as PowerPoint slide