Getaw Worku Hassen1, Ana Costea2, Tennyson Smith3, Claire Carrazco4, Hafiz Hussein5, Bahareh Soroori-Rad5, Sonia Vaidian6, Justin Seashore7, Edris Alderwish5, Wei Sun8, Alice Chen4, Bonnie Simmons9, Shakeel Usmani9, Hossein Kalantari2, George Fernaine10. 1. Department of Emergency Medicine, New York Medical College, Metropolitan Hospital Center, New York, New York; Department of Emergency Medicine, Mount Sinai School of Medicine, Lutheran Medical Center, Brooklyn, New York; Department of Emergency Medicine, St. George's School of Medicine, St. George, Grenada, West Indies. 2. Department of Emergency Medicine, New York Medical College, Metropolitan Hospital Center, New York, New York. 3. Medgar Evers College, Brooklyn, New York. 4. A.T. Still University, School of Osteopathic Medicine, Mesa, Arizona. 5. Department of Internal Medicine, Mount Sinai School of Medicine, Lutheran Medical Center, Brooklyn, New York. 6. Department of Emergency Medicine, Lutheran Medical Center, Brooklyn, New York. 7. Department of Internal Medicine, Mount Sinai School of Medicine, Elmhurst Hospital Center, Queens, New York. 8. Department of Internal Medicine, Harvard University School of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts. 9. Department of Emergency Medicine, Mount Sinai School of Medicine, Lutheran Medical Center, Brooklyn, New York. 10. Department of Internal Medicine, Division of Cardiology, Mount Sinai School of Medicine, Lutheran Medical Center, Brooklyn, New York.
Abstract
BACKGROUND: The electrocardiogram (ECG) is the most important diagnostic tool for acute myocardial infarction (AMI). T wave inversion (TWI) in lead aVL has not been emphasized or well recognized. OBJECTIVE: This study examined the relationship between the presence of TWI before the event and mid-segment left anterior descending (MLAD) artery lesion in patients with AMI. METHODS: Retrospective charts of patients with acute coronary syndrome between the months of January 2009 and December 2011 were reviewed. All patients with MLAD lesion were identified and their ECG reviewed for TWI in lead aVL. RESULTS: Coronary angiography was done on 431 patients. Of these, 125 (29%) had an MLAD lesion. One hundred and six patients (84.8%) had a lesion > 50% and 19 patients (15.2%) had a lesion < 50%. Of the 106 patients who had a MLAD lesion > 50%, 90 patients (84.9%) had TWI in lead aVL and one additional lead. Of the 19 patients who had an MLAD lesion < 50%, 8 patients (42.1%) had TWI in lead aVL and one additional lead. Isolated TWI in lead aVL had an overall sensitivity of 76.7% (95% confidence interval [CI] 0.65-0.86), a specificity of 71.4% (95% CI 0.45-0.88), a positive predictive value of 92%, a negative predictive value of 41.7%, a positive likelihood ratio of 2.7 (95% CI 1.16-6.22), and negative likelihood ratio of 0.32 (95% CI 0.19-0.58) for predicting a MLAD lesion of > 50% (p = 0.0011). CONCLUSIONS: TWI in lead aVL might signify a mid-segment LAD lesion. Recognition of this finding and early appropriate referral to a cardiologist might be beneficial. Additional studies are needed to validate this finding. Published by Elsevier Inc.
BACKGROUND: The electrocardiogram (ECG) is the most important diagnostic tool for acute myocardial infarction (AMI). T wave inversion (TWI) in lead aVL has not been emphasized or well recognized. OBJECTIVE: This study examined the relationship between the presence of TWI before the event and mid-segment left anterior descending (MLAD) artery lesion in patients with AMI. METHODS: Retrospective charts of patients with acute coronary syndrome between the months of January 2009 and December 2011 were reviewed. All patients with MLAD lesion were identified and their ECG reviewed for TWI in lead aVL. RESULTS: Coronary angiography was done on 431 patients. Of these, 125 (29%) had an MLAD lesion. One hundred and six patients (84.8%) had a lesion > 50% and 19 patients (15.2%) had a lesion < 50%. Of the 106 patients who had a MLAD lesion > 50%, 90 patients (84.9%) had TWI in lead aVL and one additional lead. Of the 19 patients who had an MLAD lesion < 50%, 8 patients (42.1%) had TWI in lead aVL and one additional lead. Isolated TWI in lead aVL had an overall sensitivity of 76.7% (95% confidence interval [CI] 0.65-0.86), a specificity of 71.4% (95% CI 0.45-0.88), a positive predictive value of 92%, a negative predictive value of 41.7%, a positive likelihood ratio of 2.7 (95% CI 1.16-6.22), and negative likelihood ratio of 0.32 (95% CI 0.19-0.58) for predicting a MLAD lesion of > 50% (p = 0.0011). CONCLUSIONS: TWI in lead aVL might signify a mid-segment LAD lesion. Recognition of this finding and early appropriate referral to a cardiologist might be beneficial. Additional studies are needed to validate this finding. Published by Elsevier Inc.
Entities:
Keywords:
ECG; T wave inversion in lead aVL; mid-segment LAD lesion