Prevalence Of T-wave Inversion Research Articles

PREVALENCE AND PROGNOSTIC VALUE OF T-WAVE INVERSION IN HYPERTENSIVE PATIENTS: A 5-YEAR FOLLOW-UP STUDY

Objective: Data on prevalence and associated prognosis of repolarization abnormalities among hypertensive patients are limited. We investigated the presence and extent of ST-segment and T-wave changes in a hypertensive population and their predictive ability for cardiovascular disease. Design and method: We studied 1851 white Caucasian hypertensive patients (age 58±12years, 51% females) without a history of cardiovascular disease for a mean period of 5.3±3.4 years. At the baseline examination, all patients underwent standard 12-lead electrocardiography. T-wave inversion (TWI) was defined as T-wave deflection > -0.1 mV in > 2 contiguous leads, unless associated with bundle branch block. Anterior, lateral, or inferior TWI was defined as TWI in leads V2-V4 or V5, V6, I, AVL or II, aVF respectively. The depth in millimeters of TWI in each lead was recorded and the maximum depth per location was calculated. ST depression was defined as >1 mm in depth in two or more contiguous leads. During follow-up, patients underwent clinic visits at least yearly for management of hypertension and risk factors. The outcome studied was the incidence of cardiovascular morbidity set as the composite of non-fatal coronary artery disease and stroke. Results: In the entire population, prevalence of TWI was 3.8%, of which 39% presented with anterior TWI, 73% with lateral TWI and 11% with inferior TWI. ST depression was observed in 3.6% of patients (anterior in 0.8%, inferior in 0.9% and lateral in 2.6%). Incidence of the composite endpoint during follow-up was 4%. Cox regression analysis revealed that presence of TWI was associated with a significantly greater risk for cardiovascular events (HR: 2.6, 95% CI: 1.1-5.9, p=0.025). The association was stronger for lateral TWI (HR: 3.3, 95%: CI: 1.34-8.30, p=0.01) compared to other locations. In multivariate models controlling for standard confounders these associations were overall sustained. Depth of TWI and presence of ST depression were not associated with cardiovascular risk. Conclusions: Among hypertensive patients without cardiovascular disease, TWI is infrequent but significantly associated with future cardiovascular events. Lateral TWI carries the worse prognosis.

The Impact of Ethnicity on Athlete ECG Interpretation: A Systematic Review

Athlete ECG interpretation criteria have been developed and refined from research in athlete populations; however, current guidelines are based on available data primarily from Caucasian and Black athletes. This study aimed to assess the impact of ethnicity on ECG interpretation in athletes. A systematic review was conducted of the MEDLINE, EMBASE, Scopus, SPORTDiscus, and Web of Science databases, for papers that assessed athlete screening ECGs and compared findings on the basis of ethnicity. Fifty-one papers which compared ECGs from various ethnicities were included. Most studies assessed Black athletes against Caucasian athletes and found a greater prevalence of T-wave inversion (TWI) (2.6–22.8% vs. 0–5.0%) and anterior TWI (3.7–14.3% vs. 0.6–2.0%). Black athlete subgroups in Africa had TWI (20–40%) and anterior TWI (4.3–18.7%) at a higher prevalence than other Black athletes. Athletes who were defined as mixed-race, Asian, and Pacific Islander are potentially more like Black athletes than Caucasian athletes. Black ethnicity is known to have an impact on the accurate interpretation of athlete ECGs; however, there is nuance related to origin of both parents. Asian and Pacific Islander origin also may impact athlete ECG interpretation. Further research is required to assist in distinguishing abnormal and normal athlete ECGs in different ethnic populations.

Prevalence, pattern and associated cardiovascular risk of t-wave inversion in hypertensive patients: a 5-year follow-up study

Abstract Background Data on prevalence and associated prognosis of repolarization abnormalities among hypertensive patients are limited. Purpose We investigated the presence and extent of ST-segment and T-wave changes in a hypertensive population and their predictive ability for cardiovascular disease. Methods We studied 1851 white Caucasian hypertensive patients (age 58±12 years, 51%females) without a history of cardiovascular disease for a mean period of 5.3±3.4 years. At the baseline examination, all patients underwent standard 12-lead electrocardiography. T-wave inversion (TWI) was defined as T-wave deflection ≥−0.1 mV in ≥2 contiguous leads,unless associated with bundle branch block. Anterior, lateral or inferior TWI was defined as TWIin leads V2-V4 or V5,V6, I, AVL or II, aVF respectively. Thedepth in millimeters of TWI in each lead was recorded and the maximum depth per location was calculated. ST depression was defined as ≥1mm in depth in two or more contiguous leads.During follow-up, patients underwent clinic visits at least yearly for management of hypertension and risk factors. The outcome studied was theincidence of cardiovascular morbidity set as the composite of non-fatal coronary artery disease and stroke. Results In the entire population, prevalence of TWI was 3.8%, of which 39% presented withanterior TWI, 73% withlateral TWI and 11% with inferior TWI. ST depression was observed in 3.6% of patients (anterior in 0.8%, inferior in 0.9% and lateral in 2.6%). Incidence of the composite endpoint during follow-up was 4%. Cox regression analysis revealed that presence of TWI was associated with a significantly greater risk for cardiovascular events (HR: 2.6, 95% CI: 1.1–5.9, p=0.025). The association was stronger for lateral TWI (HR: 3.3, 95%: CI: 1.34–8.30, p=0.01) compared to other locations. In multivariate models controlling for standard confounders these associations were overall sustained. Depth of TWI and presence of ST depression were not associated with cardiovascular risk. Conclusions Among hypertensive patients without cardiovascular disease, TWI is infrequent but significantly associated with future cardiovascular events.Lateral TWI carries the worse prognosis Funding Acknowledgement Type of funding source: None

The prevalence and correlates of T-wave inversion in lead III in non-obese men

BackgroundT-wave inversion in lead III was linked to displacement of the base of the heart due to abdominal adipose tissue in early electrocardiography (ECG) trials. The observation of T-wave inversion in lead III in some of the pathological and physiological conditions other than obesity suggests the possibilities of different mechanisms. We aimed to investigate the prevalence and correlates of T-wave inversion in lead III in non-obese men. MethodA total of 1240 men underwent ECG, blood pressure measurement, hepatic ultrasonography, and biochemical tests from January 2019 to December 2019. We excluded 220 subjects due to predetermined criteria. The eligible 105 non-obese men with T-wave inversion in lead III and 915 non-obese men without T-wave inversion in lead III were compared with each other in terms of clinical, demographic and laboratory parameters. ResultsThe mean age was 27.9 years with a range of 20 to 46 years. The prevalence of T-wave inversion in lead III was 10.3%. Body mass index (BMI), blood urea nitrogen, creatinine, alanine aminotransferase, hematocrit, and the percentage of non-alcoholic fatty liver disease (NAFLD) were significantly higher in Group with T-wave inversion while alkaline phosphatase was significantly higher in Group without T-wave inversion. In multivariable analysis, NAFLD was the best independent correlate of inverted T-wave in lead III (β = 6.215, p < 0.0001). BMI (β = 1.448, p < 0.001) and hematocrit (β = 1.179, p = 0.021) were the other independent correlates of T-wave inversion in lead III. ConclusionWe demonstrated the association of T-wave inversion in lead III with NAFLD, BMI, and hematocrit in non-obese men.

Correction: Impact of ethnicity on cardiac adaptation to exercise

Nat. Rev. Cardiol. advance online publication 25 February; 10.1038/nrcardio.2014.15 In the version of this article initially published online and in print, Figure 10 incorrectly stated that the prevalence of T-wave inversions in black athletes who might also exhibit coexisting right ventricular dilatation was 45%, instead of 14.

Letter by Assenza et al Regarding Article, “Electrocardiographic Features of Arrhythmogenic Right Ventricular Dysplasia”

To the Editor: We read with interest the article by Jain et al1 about the ECG features of arrhythmogenic right ventricular cardiomyopathy (ARVC). The authors tested the diagnostic performance of different surface ECG features in a cohort of patients with a previous clinical diagnosis of ARVC based on 1994 Task Force criteria (recently, revised Task Force Criteria have been proposed).2 They included 15 patients with so-called incomplete right bundle-branch block and 17 patients with complete right bundle-branch block. Including patients with right ventricular conduction delay is very relevant because the 1994 Task Force consensus statement on ARVC diagnosis …

Electrocardiographic Features of Arrhythmogenic Right Ventricular Dysplasia

The purpose of this study was to reevaluate the ECG features of arrhythmogenic right ventricular dysplasia (ARVD). The second objective was to evaluate the sensitivity and specificity of the standard and newly proposed diagnostic ECG markers in the presence of a right bundle-branch block (RBBB). One hundred patients with ARVD (57 men; aged 39+/-15 years) and 57 controls (21 men; aged 40+/-17 years) were included. Among the 100 patients with ARVD, a complete RBBB was present in 17 patients, and 15 patients had an incomplete RBBB. T-wave inversion through V(3) demonstrated optimal sensitivity and specificity in both ARVD patients without a complete RBBB or incomplete RBBB (71% [95% confidence interval, 58% to 81%] and 96% [95% confidence interval, 81% to 100%], respectively) and in ARVD patients with incomplete RBBB (73% [95% confidence interval, 45% to 92%] and 95% [95% confidence interval, 77% to 100%], respectively). Between ARVD patients and controls with a complete RBBB, the only 2 parameters that differed were the prevalence of T-wave inversion through V(4) (59% versus 12%, respectively; P<0.05) and an r'/s ratio in V(1) <1 (88% versus 14%, respectively; P<0.005). In ARVD patients with complete RBBB, the most sensitive and specific parameter was an r'/s ratio <1. We evaluated comprehensively the diagnostic value of ECG markers for ARVD. On the basis of the findings, we propose an algorithm, with examination of QRS morphology being the first step, for ECG evaluation of ARVD patients. Definite criteria are then applied on the basis of the presence of no RBBB, incomplete RBBB, and complete RBBB to obtain the best diagnostic utility of the ECG.

Prevalence and significance of T-wave inversions in predominantly Caucasian adolescent athletes

Athletic activity is associated with electrocardiographic T-wave inversions in some adults, resembling those observed in cardiomyopathy. The prevalence and significance of T-wave inversions in adolescent athletes, the group most vulnerable to exercise-related sudden death from cardiomyopathy, is unknown. This study evaluated 1710 adolescent athletes and 400 healthy controls. Subjects with T-wave inversions underwent intensive cardiac investigations to identify a potential cause. There was no significant difference in the overall prevalence of T-wave inversions between athletes and controls (4 vs. 3%; P = 0.46). T-wave inversions in leads V1-V3 were largely confined to athletes and controls aged <16 years. Only 0.1% of athletes aged >or=16 years exhibited T-wave inversions beyond V2. T-wave inversions in the inferior and/or lateral leads and deep T-wave inversions occurred infrequently in athletes (1.5 and 0.8%, respectively) and were associated with a high prevalence of left ventricular hypertrophy or congenital cardiac anomalies. Despite intensive investigations, no athlete was diagnosed with a cardiomyopathy. T-wave inversions in V1-V3 are relatively common in athletes <16 years and probably represent the juvenile electrocardiogram pattern. In adolescent athletes, T-wave inversions beyond V2 if >or=16 years, T-wave inversions in the inferior/lateral leads and deep T-wave inversions in any lead are unusual, warranting further investigations for underlying cardiomyopathy.

Abstract 4116: Electrocardiographic Markers of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy: A reappraisal

Background: The Task Force criteria for diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) rely on depolarization and repolarization abnormalities detected on a surface ECG. Terminal activation delay (TAD) has recently been presented as specific and sensitive marker of ARVD/C. The purpose of this study was to evaluate the sensitivity and specificity of TAD in patients with ARVD/C. Methods : In a cohort of 74 patients with definite ARVD/C (51% male); age 36 ± 12 years) and 48 phenotypically normal non cardiac patients (35% male); age 35 ± 14 years) we studied the ECG criteria used to diagnose ARVD/C with specific a focus on TAD. The parameters analyzed were: T wave inversion (TWI) in ≥ V2, TWI ≥ V3, epsilon wave, QRS ≥ 110ms in V1 to V3, parietal block defined as QRSd V1–V6 or V2–V6 or V3–V6 &gt;25 ms in the presence of QRS ≥ 100ms in at least 2 right precordial leads, TAD in V1-V3 and QRSd in V1+V2+V3/V4+V5+V6 ≥ 1.2. Sigma scan software was used for the ECG analysis. Results : In the ARVD/C group, the prevalence of TWI ≥ V2 was 82%, TWI ≥ V3 was 66%, epsilon wave: 1%, QRSd ≥ 110ms V1-V3: 39%, parietal block: 16%, TAD: 46 %, QRSd ratio ≥ 1.2: 19%. In the non cardiac group the prevalence of TWI ≥ V2 was 6 %, TWI ≥ V3: 6%, epsilon wave: 0%, QRSd ≥ 110ms V1–V3: 4%, parietal block: 2%, TAD: 12%, and QRSd ratio ≥ 1.2: 4% (Figure). Conclusion : The results of this study reveal that terminal activation delay has only moderate sensitivity and specificity for the diagnosis of ARVD/C. Our results also reveal that T wave inversion in the right precordial leads is a very sensitive marker of ARVD/C.

A comparison of T-wave inversion, S-T elevation, and RS amplitudes in precordial leads of Africans and Indians in Guyana

ECG precordial leads of 830 Guyanese men and women of African and Indian origin, aged 35 to 54 years, were compared. The prevalence of nonupright T waves in right precordial leads (V 1 to V 3) were similar in the two ethnic groups. T-wave inversion in V 1, V 2, and V 3 was present in 46.4 per cent, 3.5 per cent, and 2.4 per cent of women, respectively, compared with 9.6 per cent in V 1 and no inversion in V 2 and V 3 in men. S-T elevation occurring in any of the precordial leads was present in 2.1 per cent of African women, 0.9 per cent of Indian women, 18.1 per cent of African men, and 13.6 per cent of Indian men. Neither T-wave inversion in right precordial leads nor S-T elevation were associated with detectable clinical abnormality, hypertension, obesity, or raised blood cholesterol levels and both appeared to be normal variants. S-T elevation was associated with large QRS complexes. Mean amplitudes of S waves in V 1 and R waves in V 5 and V 6 were significantly greater in men than in women and in Africans than Indians. These differences could only be partially explained by variations in age, blood pressure, obesity, or cardiothoracic ratios. Possible ethnic and sex differences in the prevalence of T-wave inversion in right precordial leads, S-T elevation, and high amplitude QRS complexes can be of clinical and epidemiological importance.