Abstract
Objective
The goal of the current work was to assess the possible relationship between upright T wave in precordial lead V1 (TV1) and the occurrence of coronary artery disease (CAD) in patients undergoing coronary angiography with an otherwise unremarkable resting electrocardiogram (ECG).
Methods
Twelve-lead resting ECGs of 2,468 patients who underwent coronary angiography were analyzed by independent reviewers blinded to the patients’ clinical data. Patients with any condition known to affect cardiac repolarization were not eligible for inclusion.
Results
Of 126 patients included in the study, 76 (60%) had at least one significant coronary artery stenosis. Significant CAD was more frequently found in patients with upright TV1 as compared to those with negative TV1 (74 vs. 43%, p = 0.001). Left circumflex (LCx) and left anterior descending (LAD) coronary artery lesions were more frequently observed in patients with upright TV1 than in those with inverted TV1. In univariate analysis, patients with upright TV1 were approx 4 times more likely to have significant CAD than those with inverted TV1 (odds ratio (OR) 3.7, 95% confidence interval (CI) 1.744–7.897). In addition, in the multivariate logistic regression model, upright TV1 was an independent predictor of significant CAD (OR 4.249, 95% CI 1.594–11.328), along with previous myocardial infarction (OR 17.533, 95% CI 3.338–92.091), male gender (OR 3.020; 95% CI 1.214–7.510), and age (OR 1.061; 95% CI 1.003–1.122).
Conclusion
It might be worthwhile to routinely evaluate the polarity of the T wave in lead V1 in patients with suspected CAD, since it appears to have additional risk stratification potential.
Zusammenfassung
Ziel
Ziel war zu untersuchen, ob eine Beziehung besteht zwischen einer positiven T-Welle in Brustwandableitung V1 (TV1) und dem Auftreten einer koronaren Herzkrankheit (KHK) bei Patienten, die sich einer Koronarangiographie unterziehen und ansonsten ein unauffälliges Ruhe-Elektrokardiogramm (EKG) aufweisen.
Methoden
Von unabhängigen Untersuchern, die in Bezug auf die klinischen Daten der Patienten verblindet waren, wurden 12-Kanal-EKGs von 2468 Koronarangiographiepatienten ausgewertet. Nicht in die Studie aufgenommen wurden Patienten mit Erkrankungen, die sich auf die kardiale Repolarisation auswirken können.
Ergebnisse
Von 126 Patienten, die in die Studie aufgenommen wurden, wiesen 76 (60%) mindestens eine signifikante Koronararterienstenose auf. Eine bedeutsame KHK fand sich häufiger bei Patienten mit positiver als mit negativer TV1 (74 vs. 43%; p = 0,001). Läsionen des Ramus circumflexus (LCx) und des Ramus interventricularis anterior (LAD) der A. coronaria sinistra wurden häufiger bei Patienten mit positiver als mit invertierter TV1 beobachtet. In der univariaten Analyse war die Wahrscheinlichkeit einer bedeutsamen KHK 4-mal höher bei Patienten mit positiver als mit invertierter TV1 (Odds Ratio, OR: 3,7; 95%-Konfidenzintervall, 95%-KI: 1,744–7,897). Außerdem war eine positive TV1 im multivariaten logistischen Regressionsmodell ein unabhängiger Prädiktor für eine bedeutsame KHK (OR: 4,249; 95%-KI: 1,594–11,328), zusammen mit früherem Herzinfarkt (OR: 17,533; 95%-KI: 3,338–92,091), männlichem Geschlecht (OR: 3,020; 95%-KI: 1,214–7,510) und dem Alter (OR: 1,061; 95%-KI: 1,003–1,122).
Fazit
Die routinemäßige Beurteilung der Polarität der T-Welle in der Ableitung V1 könnte bei Patienten mit Verdacht auf KHK lohnenswert sein, da sie ein zusätzliches Risikostratifizierungspotenzial aufzuweisen scheint.
This is a preview of subscription content, log in via an institution to check access.
References
Savage RM, Wagner GS, Ideker RE et al (1977) Correlation of postmortem anatomic findings with electrocardiographic changes in patients with myocardial infarction. Circulation 55:279–285
Kataoka H (1994) Relation of T-wave polarity in precordial V1 lead to right or left circumflex coronary pathoanatomy in acute inferior myocardial infarction. Chest 105(2):360–363
Manno BV, Hakki AH, Iskandrian AS, Hare T (1983) Significance of the upright T wave in precordial lead V1 in adults with coronary artery disease. J Am Coll Cardiol 1(5):1213–1215
Wagner GS, Marriott HJL (2001) Interpretation of the normal electrocardiogram. In: Wagner GS (ed) Marriott’s practical electrocardiography, 10th edn. Lippincott, Williams & Wilkins, Philadelphia, PA, pp 24–25
Mirvis DM, Goldberger AL (2007) Electrocardiography. In: Zipes DP, Libby P, Bonow R, Braunwald E (eds) Braunwald’s heart disease: a textbook of cardiovascular disease, 8th edn. WB Saunders, Philadelphia, PA, pp 159–160
Tuvemo T (1982) T wave changes in the right precordial leads in seven- and eight-year-old children during a Valsalva manoeuvre. J Electrocardiol 15(4):325–326
Rautaharju PM, Surawicz B, Gettes LS et al (2009) AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol 53(11):982–991
Onat T, Onat A, Can G (2008) Negative T wave in chest lead V1: relation to sex and future cardiovascular risk factors. Turk Kardiyol Dern Ars 36(8):513–518
Wu J, Kors JA, Rijnbeek PR et al (2003) Normal limits of the electrocardiogram in Chinese subjects. Int J Cardiol 87(1):37–51
Rautaharju PM, Kooperberg C, Larson JC, LaCroix A (2006) Electrocardiographic abnormalities that predict coronary heart disease events and mortality in postmenopausal women: the Women’s Health Initiative. Circulation 113(4):473–480
Weyn AS, Marriott HJL (1962) The TV1 taller than TV6: its potential value in the early recognition of myocardial disease. Am J Cardiol 10:764–766
Nalbantgil S, Yilmaz H, Gurgun C et al (1999) Reevaluation of an old electrocardiographic criterion for coronary disease: TV1 > TV6. Annals of Noninvasive Electrocardiology 4:397–400
Rose G, Baxter PJ, Reid DD, McCartney P (1978) Prevalence and prognosis of electrocardiographic findings in middle-aged men. Br Heart J 40(6):636–643
CASS principal investigators and their associates (1983) Coronary Artery Surgery Study (CASS). A randomized trial of coronary artery bypass surgery. Survival data. Circulation 68:939–950
Sox HC Jr, Garber AM, Littenberg B (1989) The resting electrocardiogram as a screening test: a clinical analysis. Ann Intern Med 111:489–502
Pedoe HD (1978) Predictability of sudden death from the resting electrocardiogram: effect of previous manifestations of coronary heart disease. Br Heart J 40:630–635
Robson J, Feder G (2001) Predicting and reducing cardiovascular risk. Heart 85:487–488
Allwork SP (1987) The applied anatomy of the arterial blood supply to the heart in man. J Anat 153:1–16
Sahni D, Jit I (1990) Blood supply of the human interventricular septum in north-west Indians. Indian Heart J 42(3):161–169
Acknowledgment
We would like to express our gratitude to Beatrix Viktoria Lee Yuan-Ling for her generous assistance during final manuscript preparation.
Conflict of interest
The corresponding author states that there are no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
All authors had access to the data and a role in writing the manuscript.
Rights and permissions
About this article
Cite this article
Stankovic, I., Milekic, K., Vlahovic Stipac, A. et al. Upright T wave in precordial lead V1 indicates the presence of significant coronary artery disease in patients undergoing coronary angiography with otherwise unremarkable electrocardiogram. Herz 37, 756–761 (2012). https://doi.org/10.1007/s00059-011-3577-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00059-011-3577-6