Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology University Hospital Basel, University of Basel, Switzerland; Department of Cardiac Surgery, University Hospital Basel, University of Basel, Switzerland; GREAT network.
Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology University Hospital Basel, University of Basel, Switzerland; GREAT network.
Ann Emerg Med. 2023 Aug;82(2):194-202. doi: 10.1016/j.annemergmed.2022.12.003. Epub 2023 Feb 10.
The diagnostic performance of T-wave amplitudes for the detection of myocardial infarction is largely unknown. We aimed to address this knowledge gap.
T-wave amplitudes were automatically measured in 12-lead ECGs of patients presenting with acute chest discomfort to the emergency department within a prospective diagnostic multicenter study. The final diagnosis was centrally adjudicated by 2 independent cardiologists. Patients with left ventricular hypertrophy, complete left bundle branch block, or paced ventricular depolarization were excluded. The performance for lead-specific 95th-percentile thresholds were reported as likelihood ratios (lr), specificity, and sensitivity.
Myocardial infarction was the final diagnosis in 445 (18%) of 2457 patients. In most leads, T-wave amplitudes tended to be greater in patients without myocardial infarction than those with myocardial infarction, and T-wave amplitude exceeding the 95th percentile had positive and negative lr close to 1 or with confidence intervals (CIs) crossing 1. The exceptions were leads III, aVR, and V1, which had positive lrs of 3.8 (95% CI, 2.7 to 5.3), 4.3 (95% CI, 3.1 to 6.0) and 2.0 (95% CI, 1.4 to 2.9), respectively. These leads normally have inverted T waves, so T-wave amplitude exceeding the 95th percentile reflects upright rather than increased-amplitude hyperacute T waves.
Hyperacute T waves, when defined as increased T-wave amplitude exceeding the 95th percentile, did not provide useful information in diagnosing myocardial infarction in this sample.
T 波幅度在心肌梗死检测中的诊断性能尚不清楚。我们旨在解决这一知识空白。
在一项前瞻性诊断多中心研究中，对因急性胸痛就诊于急诊科的患者 12 导联心电图进行 T 波幅度自动测量。最终诊断由 2 位独立心脏病专家进行中心裁决。排除存在左心室肥厚、完全左束支传导阻滞或起搏心室除极的患者。报告了导联特异性 95%百分位阈值的表现，包括似然比（lr）、特异性和敏感性。
在 2457 例患者中，445 例（18%）最终诊断为心肌梗死。在大多数导联中，无心肌梗死患者的 T 波幅度通常大于心肌梗死患者，且 T 波幅度超过 95%百分位时，阳性和阴性 lr 接近 1 或置信区间（CI）接近 1。例外的是导联 III、aVR 和 V1，其阳性 lr 分别为 3.8（95%CI，2.7 至 5.3）、4.3（95%CI，3.1 至 6.0）和 2.0（95%CI，1.4 至 2.9）。这些导联通常具有倒置的 T 波，因此 T 波幅度超过 95%百分位反映的是直立而不是振幅增加的超急性期 T 波。
在本样本中，将超急性期 T 波定义为增加的 T 波幅度超过 95%百分位时，并未提供有用的心肌梗死诊断信息。
