Document Type : Original Article(s)
- Mohammad Hadi Mansouri 1
- Hamid Sanei 2
- Pejman Mansouri 3
- Sahar Behnam-Roudsari 4
- Hasan Shemirani 5
- Reihaneh Zavar 6
1 Assistant Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
2 Professor, Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
3 Resident, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
4 General Practitioner, Qazvin University of Medical Sciences, Qazvin, Iran
5 Professor, Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
6 Assistant Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
BACKGROUND: The aim of this study was to predict significant coronary artery disease (CAD) in patients undergoing coronary angiography.METHODS: In this cross-sectional study, data of 384 patients who underwent angiography during 2015-2017 were reviewed. Electrocardiograms (ECGs) were evaluated in terms of having positive T wave in lead V1 (TV1) described as T wave with amplitude of more than 0.15 mV and angiography records were assessed for presence of significant CAD defined as presence of ≥ 70% internal diameter stenosis in at least one major epicardial coronary artery or more than 50% stenosis in left main artery (LMA).RESULTS: Out of 384 patients who participated in this study with mean age of 63.6 ± 10.2 years (40-89 years), 71.6% showed positive TV1 and significant CAD simultaneously and left anterior descending artery (LAD) and left circumflex artery (LCX) lesions were more frequently reported in coronary angiography. Based on chi-square test, the prevalence of significant CAD was obviously more in those with positive TV1 as compared to those without this finding [odds ratio (OR) = 2.74, 95% confidence interval (CI): 1.80-4.19, P < 0.001]. Mann-Whitney test showed significant difference in number of coronary arteries involved in CAD between presence of positive and negative T wave in lead V1 (P < 0.001). Great number of patients with significant CAD had remarkably higher T wave amplitude in lead V1 in comparison to lead V6 (OR = 6.22, 95% CI: 3.14-12.30, P < 0.001).CONCLUSION: Positive TV1 and TV1 > TV6 pattern can be considered as a predictor forsignificant CAD in patients with otherwise normal ECG.
- Sayols-Baixeras S, Lluis-Ganella C, Lucas G, Elosua R. Pathogenesis of coronary artery disease: Focus on genetic risk factors and identification of genetic variants. Appl Clin Genet 2014; 7: 15-32.
- Islam AK, Majumder AA. Coronary artery disease in Bangladesh: A review. Indian Heart J 2013; 65(4): 424-35.
- Mahmoodzadeh S, Moazenzadeh M, Rashidinejad H, Sheikhvatan M. Diagnostic performance of electrocardiography in the assessment of significant coronary artery disease and its anatomical size in comparison with coronary angiography. J Res Med Sci 2011; 16(6): 750-5.
- Acharya UR, Fujita H, Lih OS, Adam M, Tan JH, Chua CK. Automated detection of coronary artery disease using different durations of ECG segments with convolutional neural network. Knowl Based Syst 2017; 132: 62-71.
- Stankovic I, Milekic K, Vlahovic Stipac A., Putnikovic B, Panic M, Vidakovic R, 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 2012; 37(7): 756-61.
- Lin KB, Shofer FS, McCusker C, Meshberg E, Hollander JE. Predictive value of T-wave abnormalities at the time of emergency department presentation in patients with potential acute coronary syndromes. Acad Emerg Med 2008; 15(6): 537-43.
- Kayed M, Ramzy A, Yassin I, Kotb E. Diagnostic Value of Electrocardiographic ST-T Wave Changes in Lead aVL in Patients with Chronic Stable Angina. Egypt J Hosp Med 2019; 74(1): 110-6.
- Kashou AH, May AM, DeSimone CV, Deshmukh AJ, Asirvatham SJ, Noseworthy PA. Diffuse ST-segment depression despite prior coronary bypass grafting: An electrocardiographic-angiographic correlation. J Electrocardiol 2019; 55: 28-31.
- Separham A, Sohrabi B, Tajlil A, Pourafkari L, Sadeghi R, Ghaffari S, et al. Prognostic value of positive T wave in lead aVR in patients with non-ST segment myocardial infarction. Ann Noninvasive Electrocardiol 2018; 23(5): e12554.
- Arkin BM, Hueter DC, Ryan TJ. Predictive value of electrocardiographic patterns in localizing left ventricular asynergy in coronary artery disease. Am Heart J 1979; 97(4): 453-9.
- Saito M, Asonuma H, Tomita M, Sumiyoshi T, Haze K, Fukami K, et al. Differentiation of myocardial ischemia and left ventricular aneurysm in the genesis of exercise-induced ST-T changes in previous anterior myocardial infarction. Jpn Circ J 1987; 51(5): 503-10.
- Ekizler FA, Cay S, Kafes H, Ozeke O, Ozcan F, Topaloglu S, et al. The prognostic value of positive T wave in lead aVR: A novel marker of adverse cardiac outcomes in peripartum cardiomyopathy. Ann Noninvasive Electrocardiol 2019; 24(3): e12631.
- Kataoka H. Relation of T-wave polarity in precordial V1 lead to right or left circumflex coronary pathoanatomy in acute inferior myocardial infarction. Chest 1994; 105(2): 360-3.
- Yang HJ, Liu X, Qu C, Shi SB, Yang B. Usefulness of upright T wave in lead aVR for predicting short-term prognosis of patients with ischemic stroke. Chronic Dis Transl Med 2018; 4(3): 192-8.
- Weyn AS, Marriott HJ. The T-V1 taller than T-V6 pattern. Its potential value in the early recognition of myocardial disease. Am J Cardiol 1962; 10: 764-6.
- Nalbantgil S, Yilmaz H, Gurgun C, Gurcay B, Zoghi M, Nalbantgil I, et al. Reevaluation of an old electrocardiographic criterion for coronary disease: TV1 > TV6. Ann Noninvasive Electrocardiol 1999; 4(4): 397-400.
- Kligfield P, Gettes LS, Bailey JJ, Childers R, Deal BJ, Hancock EW, et al. Recommendations for the standardization and interpretation of the electrocardiogram: part I: The electrocardiogram and its technology 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 2007; 49(10): 1109-27.
- Tuvemo T. T wave changes in the right precordial leads in seven- and eight-year-old children during a Valsalva manoeuvre. J Electrocardiol 1982; 15(4): 325-6.
- Pirkola JM, Konttinen M, Kentta TV, Holmstrom LTA, Junttila MJ, Ukkola OH, et al. Prognostic value of T-wave morphology parameters in coronary artery disease in current treatment era. Ann Noninvasive Electrocardiol 2018; 23(4): e12539.
- Pinto IJ, Nanda NC, Biswas AK, Parulkar VG. Tall upright T waves in the precordial leads. Circulation 1967; 36(5): 708-16.
- Amirzadegan A, Hosseini K, Sekhavati Moghaddam E, Nozari Y, Tajdini M. Upright T wave in lead v1 as an important predictor of significant coronary artery disease in patients with chest pain. Zahedan
- J Res Med Sci 2017; 19(12): e55105.
- Manno BV. T. Significance of upright T waves in precordial lead V1 as to its correlation with coronary artery disease and in particular the circumflex coronary artery. J Med Liban 2017; 65(4): 201.