Upright T-wave in lead aVR (UTW-aVR) is an uncommon finding with unclear significance in the absence of left bundle branch block. We evaluated the incidence of an UTW-aVR with underlying myocardial disease.
From 2340 consecutive inpatient and outpatient ECGs, 255 (11%) were identified with UTW-aVR and 2085 (89%) with normal T-wave in lead aVR (NTW-aVR). We compared the prevalence of myocardial disease using 2D Echo in 100 patients with UTW-aVR and 100 patients with NTW-aVR randomly selected from each group. Myocardial disease was defined as left ventricular systolic dysfunction (LVSD) with ejection fraction <50%, the presence of right ventricular systolic dysfunction (RVSD), or the presence of left ventricular hypertrophy with preserved systolic function (LVH).
There was no difference in age or the number of men and women in the two groups. The incidence of underlying myocardial disease was 91% in patients with UTW-aVR (LVSD: 69, LVH: 23, RVSD+LVH: 2, LVSD+RVSD: 16, and Isolated RVSD:1) and 44% in patients with NTW-aVR (LVSD: 19, LVH: 25, LVSD+LVH: 5, LVSD+RVSD: 6, and RVSD+LVH:5). The likelihood ratio for overall myocardial dysfunction in the presence of UTW-aVR was 4.86 (sens: 68%, spec: 86% & PPV: 91%, NPV: 56%). The likelihood to have LVSD in the presence of UTW-aVR was 2.53 (sens: 76%, spec: 70% & PPV: 66%, NPV: 80%).
An upright T-wave in lead aVR is a simple clinical marker of underlying myocardial disease with a very high predictive value.
A clinical tool for rapid triage of patients with underlying myocardial disease.
Utility of UTW-aVR in Diagnosing Myocardial DysfunctionMyocardial DiseaseNormal HeartTotalUTW-aVR919100NTW-aVR4357100Total13466200
V.K. Verma, None.