Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
Am J Cardiol. 2013 Aug 1;112(3):411-5. doi: 10.1016/j.amjcard.2013.03.048. Epub 2013 May 3.
Negative T waves (NTWs) in right precordial leads (V₁ to V₃) may be observed on the electrocardiogram (ECG) of healthy subjects but can also represent the hallmark of an underlying arrhythmogenic right ventricular cardiomyopathy (ARVC). It has been a consistent observation that NTWs usually become upright with exercise in healthy subjects without underlying heart disease. No systematic study has evaluated exercise-induced changes of NTWs in ARVC. We assessed the prevalence and relation to the clinical phenotype of exercise-induced right precordial NTWs changes in 35 patients with ARVC (19 men, mean age 22.2 ± 6.2 years). Forty-one healthy subjects with right precordial NTWs served as controls. At peak of exercise (mean power 149 ± 43 W, mean heart rate 83.6 ± 12.6% of target), NTWs persisted in 3 patients with ARVC (9%), completely normalized in 12 (34%), and partially reverted in 20 (57%). Patients with ARVC with or without NTWs normalization showed a similar clinical phenotype. The overall prevalence of right precordial T waves changes during exercise (normalization plus partial reversal) did not differ between patients with ARVC and controls (92% vs 88%, p = 1.0), whereas there was a statistically nonsignificant trend toward a greater prevalence of complete normalization in controls (56% vs 34%, p = 0.06). In conclusion, our study demonstrated that right precordial NTWs partially or completely revert with exercise in most patients with ARVC, and NTWs normalization is unrelated to the clinical phenotype. Exercise-induced NTWs changes are inaccurate in differentiating between ARVC patients and benign repolarization abnormalities.
心电图（ECG）中的右胸前导联（V₁ 至 V₃）的负 T 波（NTWs）在健康受试者中可能观察到，但也可能代表潜在的致心律失常性右心室心肌病（ARVC）的标志。一致的观察结果表明，在没有潜在心脏病的健康受试者中，NTWs 通常会随着运动而变为直立。没有系统的研究评估 ARVC 中运动引起的 NTWs 变化。我们评估了 35 例 ARVC 患者（男性 19 例，平均年龄 22.2 ± 6.2 岁）和 41 例右胸前导联有 NTWs 的健康对照者运动引起的右胸前 NTWs 变化的发生率及其与临床表型的关系。在运动高峰时（平均功率 149 ± 43 W，平均心率为目标心率的 83.6 ± 12.6%），3 例 ARVC 患者（9%）的 NTWs 持续存在，12 例（34%）完全正常，20 例（57%）部分恢复。有或没有 NTWs 正常化的 ARVC 患者表现出相似的临床表型。ARVC 患者和对照组中运动期间（正常化加部分恢复）右胸前 T 波变化的总发生率无差异（92%对 88%，p = 1.0），但对照组中完全正常化的发生率有统计学上的显著趋势（56%对 34%，p = 0.06）。总之，我们的研究表明，大多数 ARVC 患者的右胸前 NTWs 部分或完全随运动而恢复，NTWs 正常化与临床表型无关。运动引起的 NTWs 变化在区分 ARVC 患者和良性复极异常方面不准确。
