Document Detail

Clinical implications of isolated T wave inversion in adults: electrocardiographic differentiation of the underlying causes of this phenomenon.
MedLine Citation:
PMID:  8077547     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: This study aimed to assess the causes and clinical implications of isolated T wave inversion in adults and to evaluate electrocardiographic (ECG) differentiation of these causes. BACKGROUND: There are few previous reports on isolated T wave inversion in adults, which is a paradoxic observation in normal adults and in those with severe coronary artery disease. METHODS: We used echocardiography, stress thallium-201 scintigraphy and coronary angiography to determine the underlying causes and then used conventional electrocardiography and precordial ECG mapping to differentiate them. Eighty-six consecutive patients with isolated T wave inversion were classified as follows: group A included 23 asymptomatic patients; group B included 63 patients with chest pain. RESULTS: In group A, isolated T wave inversion was found as a normal variant in 20 patients and was due to hypertrophic cardiomyopathy in 3. In group B, the cause was hypertrophic cardiomyopathy in 3 patients, pericarditis in 2, coronary artery disease (lesions of the proximal left anterior descending coronary artery) in 39 and a normal variant in 19. The causes of isolated T wave inversion were difficult to determine from 12-lead ECG findings alone. However, when the inverted T wave region extended into the upper part of the precordium, precordial ECG mapping demonstrated excellent detection of coronary artery disease, with a sensitivity, specificity and overall accuracy of 88%, 93% and 91%, respectively. CONCLUSIONS: Isolated T wave inversion in asymptomatic adults is usually a normal variant. In patients with chest pain, isolated T wave inversions can develop in two different situations: a normal variant and severe coronary artery disease; these can be easily differentiated by precordial ECG mapping using conventional electrocardiography.
M Okada; M Yotsukura; T Shimada; K Ishikawa
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  24     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1994 Sep 
Date Detail:
Created Date:  1994-10-06     Completed Date:  1994-10-06     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  739-45     Citation Subset:  AIM; IM    
Second Department of Internal Medicine, School of Medicine, Kyorin University, Tokyo, Japan.
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MeSH Terms
Arrhythmias, Cardiac / diagnosis*,  etiology
Cardiomyopathy, Hypertrophic / complications,  diagnosis
Coronary Disease / complications,  diagnosis
Diagnosis, Differential
Middle Aged
Pericarditis / complications,  diagnosis
Predictive Value of Tests
Sensitivity and Specificity

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