Abstract: Poster Presentations |

Can An Upright T-Wave in Lead aVR be a Clinical Marker for Underlying Myocardial Disease? FREE TO VIEW

Vijay K. Verma, MD; Abdul Alkeylani, MD
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UMDNJ-Robert Wood Johnson Medical School at Cooper University Hospital, Camden, NJ


Chest. 2003;124(4_MeetingAbstracts):155S. doi:10.1378/chest.124.4_MeetingAbstracts.155S-a
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PURPOSE:  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.

METHODS:  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).

RESULTS:  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%).

CONCLUSION:  An upright T-wave in lead aVR is a simple clinical marker of underlying myocardial disease with a very high predictive value.

CLINICAL IMPLICATIONS:  A clinical tool for rapid triage of patients with underlying myocardial disease.

Utility of UTW-aVR in Diagnosing Myocardial Dysfunction

Myocardial DiseaseNormal HeartTotalUTW-aVR919100NTW-aVR4357100Total13466200

DISCLOSURE:  V.K. Verma, None.

Wednesday, October 29, 2003

12:30 PM - 2:00 PM




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