Okada M, Yotsukura M, Shimada T, Ishikawa K
Second Department of Internal Medicine, School of Medicine, Kyorin University, Tokyo, Japan.
J Am Coll Cardiol. 1994 Sep;24(3):739-45. doi: 10.1016/0735-1097(94)90023-x.
This study aimed to assess the causes and clinical implications of isolated T wave inversion in adults and to evaluate electrocardiographic (ECG) differentiation of these causes.
There are few previous reports on isolated T wave inversion in adults, which is a paradoxic observation in normal adults and in those with severe coronary artery disease.
We used echocardiography, stress thallium-201 scintigraphy and coronary angiography to determine the underlying causes and then used conventional electrocardiography and precordial ECG mapping to differentiate them. Eighty-six consecutive patients with isolated T wave inversion were classified as follows: group A included 23 asymptomatic patients; group B included 63 patients with chest pain.
In group A, isolated T wave inversion was found as a normal variant in 20 patients and was due to hypertrophic cardiomyopathy in 3. In group B, the cause was hypertrophic cardiomyopathy in 3 patients, pericarditis in 2, coronary artery disease (lesions of the proximal left anterior descending coronary artery) in 39 and a normal variant in 19. The causes of isolated T wave inversion were difficult to determine from 12-lead ECG findings alone. However, when the inverted T wave region extended into the upper part of the precordium, precordial ECG mapping demonstrated excellent detection of coronary artery disease, with a sensitivity, specificity and overall accuracy of 88%, 93% and 91%, respectively.
Isolated T wave inversion in asymptomatic adults is usually a normal variant. In patients with chest pain, isolated T wave inversions can develop in two different situations: a normal variant and severe coronary artery disease; these can be easily differentiated by precordial ECG mapping using conventional electrocardiography.
