The Ohio State University Heart and Vascular Center, Columbus, OH.
Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy.
J Am Heart Assoc. 2018 Jan 26;7(3):e007118. doi: 10.1161/JAHA.117.007118.
T-wave abnormalities are common during the acute phase of non-ST-segment elevation acute coronary syndromes, but mechanisms underlying their occurrence are unclear. We hypothesized that T-wave abnormalities in the presentation of non-ST-segment elevation acute coronary syndromes correspond to the presence of myocardial edema.
Secondary analysis of a previously enrolled prospective cohort of patients presenting with non-ST-segment elevation acute coronary syndromes was conducted. Twelve-lead electrocardiography (ECG) and cardiac magnetic resonance with T2-weighted imaging were acquired before invasive coronary angiography. ECGs were classified dichotomously (ie, ischemic versus normal/nonischemic) and nominally according to patterns of presentation: no ST- or T-wave abnormalities, isolated T-wave abnormality, isolated ST depression, ST depression+T-wave abnormality. Myocardial edema was determined by expert review of T2-weighted images. Of 86 subjects (65% male, 59.4 years), 36 showed normal/nonischemic ECG, 25 isolated T-wave abnormalities, 11 isolated ST depression, and 14 ST depression+T-wave abnormality. Of 30 edema-negative subjects, 24 (80%) had normal/nonischemic ECGs. Isolated T-wave abnormality was significantly more prevalent in edema-positive versus edema-negative subjects (41.1% versus 6.7%, =0.001). By multivariate analysis, an ischemic ECG showed a strong association with myocardial edema (odds ratio 12.23, 95% confidence interval 3.65-40.94, <0.0001). Among individual ECG profiles, isolated T-wave abnormality was the single strongest predictor of myocardial edema (odds ratio 23.84, 95% confidence interval 4.30-132, <0.0001). Isolated T-wave abnormality was highly specific (93%) but insensitive (43%) for detecting myocardial edema.
T-wave abnormalities in the setting of non-ST-segment elevation acute coronary syndromes are related to the presence of myocardial edema. High specificity of this ECG alteration identifies a change in ischemic myocardium associated with worse outcomes that is potentially reversible.
非 ST 段抬高急性冠状动脉综合征（NSTE-ACS）的急性期常出现 T 波异常，但 T 波异常发生的机制尚不清楚。我们假设，NSTE-ACS 患者 T 波异常与心肌水肿的存在相对应。
对先前入组的 NSTE-ACS 前瞻性队列研究进行了二次分析。在侵入性冠状动脉造影前采集 12 导联心电图（ECG）和心脏磁共振 T2 加权成像。ECG 以二分法（即缺血与正常/非缺血）和名义分类（即无 ST 或 T 波异常、孤立性 T 波异常、孤立性 ST 压低、ST 压低+T 波异常）。通过 T2 加权图像的专家评估确定心肌水肿。在 86 名受试者（65%为男性，59.4 岁）中，36 名表现为正常/非缺血性 ECG，25 名表现为孤立性 T 波异常，11 名表现为孤立性 ST 压低，14 名表现为 ST 压低+T 波异常。在 30 名水肿阴性的受试者中，24 名（80%）ECG 正常/非缺血。与水肿阴性受试者相比，孤立性 T 波异常在水肿阳性受试者中更为常见（41.1%比 6.7%，=0.001）。多变量分析显示，缺血性 ECG 与心肌水肿密切相关（比值比 12.23，95%置信区间 3.65-40.94，<0.0001）。在个体 ECG 谱中，孤立性 T 波异常是心肌水肿的最强预测因子（比值比 23.84，95%置信区间 4.30-132，<0.0001）。孤立性 T 波异常的特异性（93%）高，但敏感性（43%）低。
非 ST 段抬高急性冠状动脉综合征患者的 T 波异常与心肌水肿有关。这种 ECG 改变的高特异性表明，缺血性心肌存在与不良预后相关的变化，且这种变化可能是可逆的。
