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.

Graphical abstractWe 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 full-size imageDownload high-quality image (517 K)Download as PowerPoint slide