Volume 31, Issue 9 (December 2020)                   Studies in Medical Sciences 2020, 31(9): 712-716 | Back to browse issues page


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behnemoon M, Sibi H. T-wave inversion in the aVL lead is associated with severity of stenosis in the LAD artery. Studies in Medical Sciences 2020; 31 (9) :712-716
URL: http://umj.umsu.ac.ir/article-1-5153-en.html
Assistant professor of cardiology,Urmia university of medical science, Urmia, Iran (Corresponding Author) , mm_bk_80@yahoo.com
Abstract:   (22935 Views)
Background & Aims: The clinical value of T wave inversion (TWI) in the lead aVL in diagnosing coronary artery disease (CAD) remains unclear. Hence, we aim to evaluate the association between TWI in the aVL lead and the severity and location of coronary artery stenosis in elective coronary angiography.
Material and Method: Electrocardiograms (ECGs) of 167 consecutive patients undergoing elective coronary angiography were analyzed. All patients had chronic stable angina. Patients with secondary T wave inversion had been excluded (67 patients). Detailed ECG and coronary angiographic findings were interpreted by experienced cardiologists. A total of 50 patients with isolated T wave inversion in the aVL lead (without other ECG abnormalities) and 50 control subjects with normal electrocardiogram were studied.
Results: Of the 100 enrolled subjects, 54 were males and 47 were females and the mean age in this study was 63.77±9.2 years old (range 44-81). There was a significant relationship between the severity of stenosis in the LAD artery and TWI in the aVL lead (P<0.0001). The sensitivity and specificity of TWI in the aVL lead for LAD artery stenosis were 74% and 65%, respectively.
Conclusion: According to our study, TWI in the aVL lead exhibits a meaningful correlation with LAD artery stenosis, which is mostly associated with the stenosis of the middle portion of the artery, with relatively high sensitivity and specificity.
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Type of Study: Research | Subject: قلب و عروق

References
1. Williams RA. Cardiovascular disease in African American women: a health care disparities issue. J Natl Med Assoc 2009;101(6):536-40. [DOI:10.1016/S0027-9684(15)30938-X]
2. Fiuza M. Metabolic syndrome and coronary artery disease. Rev Port Cardiol 2012;31(12):779-82. [DOI:10.1016/j.repc.2012.09.005] [PMID]
3. Nozari Y, Hashemlu A, Hatmi ZN, Sheikhvatan M, Iravani A, Bazdar A, et al. Outcome of coronary artery bypass grafting in patients without major risk factors and patients with at least one major risk factor for coronary artery disease. Indian J Med Sci 2007;61(10):547-54. [DOI:10.4103/0019-5359.35804] [PMID]
4. Ebrahimi M, Kazemi-Bajestani S, Ghayour-Mobarhan M, Ferns G. Coronary artery disease and its risk factors status in Iran: a review, Iran Red Crescent Med J 2011;13(9):610-23. [DOI:10.5812/kowsar.20741804.2286]
5. Zimetbaum PJ, Josephson Mark E. Use of the electrocardiogram in acute myocardial infarction. N Engl J Med 2003;348(10):933-40.T-wave inversion in the aVL lead is associated with severity of stenosis in the LAD artery Mahsa Behnemoon, et al716 [DOI:10.1056/NEJMra022700] [PMID]
6. Cannon CP, McCabe CH, Stone PH, Rogers WJ, Schactman M, Thompson BW, et al. The electrocardiogram predicts one-year outcome of patients with unstable angina and non-Q wave myocardial infarction: results of the TIMI III.Registry ECG Ancillary Study. J Am Coll Cardiol 1997;30(1):133-40. [DOI:10.1016/S0735-1097(97)00160-5]
7. Nyman I, Areskog M, ARESKOG NH, Swahn E,Wallentin L. Very early risk stratification by electrocardiogram at rest in men with suspected unstable coronary heart disease. J Intern Med 1993;234(3):293-301. [DOI:10.1111/j.1365-2796.1993.tb00746.x] [PMID]
8. Okada M, Yotsukura M, Shimada T, Ishikawa K. Clinical implications of isolated T wave inversion in adults: Electrocardiographic differentiation of the underlying cause of this phenomenon. Am Heart J 1994;24(3):739-45. [DOI:10.1016/0735-1097(94)90023-X]
9. Rhinehardt J, Brady WJ, Perron AD, Mattu A. Electrocardiographic manifestations of Wellens' syndrome. Am J Emerg Med 2002;20(7):638-43. [DOI:10.1053/ajem.2002.34800] [PMID]
10. Gurm H S, Topol E J. The ECG in acute coronary syndromes: new tricks from an old dog. Heart 2005;91(7):851-853. [DOI:10.1136/hrt.2004.047258] [PMID] [PMCID]
11. Birnbaum Y, Sclarovsky S, Mager A, Strasberg B, Rechavia E. ST segment depression in aVL: a sensitive marker for acute inferior myocardial infarction. Eur Heart J 1993;14(1):4-7. [DOI:10.1093/eurheartj/14.1.4] [PMID]
12. Hira RS, Wilson JM, Birnbaum Y. Introducing a new algorithm in inferior ST-segment elevation myocardial infarction to predict the culprit artery and distinguish proximal versus distal lesions. Coron Artery Dis 2011;22(3):165-70. [DOI:10.1097/MCA.0b013e328342c748] [PMID]
13. Farhan HL, Hassan KS, Al-Belushi A, Sallam M, Al-Zakwani I. Diagnostic value of electrocardiographic T wave inversion in lead aVL in diagnosing coronary artery disease in patients with chronic stable angina. Oman Med J 2010;25(2):124. [DOI:10.5001/omj.2010.33] [PMID] [PMCID]
14. Kracoff OH, Adelman AG, Marquis J-F, Caspi A, Aldridge HE, Schwartz L. Twelve-lead electrocardiogram recording during percutaneous transluminal coronary angioplasty: Analysis of reciprocal changes. J Electrocardiol 1990;23(3):191-8. [DOI:10.1016/0022-0736(90)90156-V]
15. Kracoff OH, Adelman AG, Oettinger M, Ayzenberg O, Epstein M, Margulis G, et al. Reciprocal changes as the presenting electrocardiographic manifestation of acute myocardial ischemia. Am J Cardiol 1993;71(15):1359-62. [DOI:10.1016/0002-9149(93)90556-R]
16. Hassen GW, Costea A, Smith T, Carrazco C, Hussein H, Soroori-Rad B, et al. The neglected lead on electrocardiogram: T wave inversion in lead aVL, nonspecific finding or a sign for left anterior descending artery lesion? J Emerg Med 2014;46(2):165-70. [DOI:10.1016/j.jemermed.2013.08.079] [PMID]
17. Hassen GW, Talebi S, Fernaine G, Kalantari H. Lead aVL on electrocardiogram: emerging as important lead in early diagnosis of myocardial infarction? Am J Emerg Med 2014;32(7):785-8. [DOI:10.1016/j.ajem.2014.02.038] [PMID]
18. Rautaharju PM, Surawicz B, Gettes L. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: Endorsed by the International Society for Computerized Electrocardiology. Circulation 2009;119:e241-e250. [DOI:10.1161/CIRCULATIONAHA.108.191096]
19. Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF. Braunwald's Heart Disease E-Book: A Textbook of.Cardiovascular Medicine: Elsevier Health Sciences; 2018. [URL]
20. Nakanishi N, Goto T, Ikeda T, Kasai AJBo. Does T wave inversion in lead aVL predict mid-segment left anterior descending lesions in acute coronary syndrome? A retrospective study. BMJ open 2016;6(2):e010268. [DOI:10.1136/bmjopen-2015-010268] [PMID] [PMCID]

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