Handgrip-induced negative U-wave in electrocardiogram of hypertensive subjects.

Fu, Long Tai; Takahashi, Nagahide; Yamamoto, Machiko; Kuboki, Masao; Koyama, Soichiro

doi:10.1536/ihj.22.59

Cited by 15 publications

(6 citation statements)

References 14 publications

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“…However, as an nU may occur also in nonischemic pathologies, these must be considered as a differential diagnosis. 10,12,13,41 These data prove the value of an nU in clinical practice.…”

Section: Discussionsupporting

confidence: 52%

“…However, its association with valvular heart disease, hypertension, and other cases in which ischemia is not the problem but in which stretch due to volume overload occurs 10,12 leads to doubt ischemia as its direct cause.…”

Section: Pathogenesis Of the Negative U Wavementioning

confidence: 99%

“…With rare exceptions, a negative U wave (nU) is considered a pathologic sign, mostly of cardiac origin. 5,9,10 An nU has been reported in aortic and mitral regurgitation, myocardial hypertrophy, hypertension, [9][10][11][12][13] dilated cardiomyopathy, 14 myocardial ischemia during exercise 9,15-17 and pharmacologic tests, 5,9,18 vasospastic angina, 8,19,20 during percutaneous transluminal coronary angioplasty (PTCA), 6,7,21 with anterior descending pathology 9, 22-25 when a vast myocardial territory is involved by ischemia regardless of the culprit vessel, 7,19,26 and in previous anterior myocardial infarctions. 27,28 In 488 patients with an nU, the primary diagnosis was hypertension in 39.5%, coronary disease in 33.7%, and valvular disease in 15.4%.Of these, 81.3% with isolated aortic valvular disease had regurgitation; no evident heart disease was found in only 7.2%.…”

Section: The Negative U Wavementioning

confidence: 99%

“…41 In hypertensive patients who developed an nU during handgrip, a contemporary echo showed a transitory increase in end-diastolic dimensions. 12 In hypertensive patients with an nU, hypotensive treatment determined a reduction of both endsystolic and end-diastolic dimensions. 11 A decrease in high voltage of the QRS has been reported with regression of an nU, 10 with the high voltage attributed to dilatation of the ventricle due to the Brody effect.…”

Section: Pathogenesis Of the Negative U Wavementioning

confidence: 99%

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The negative U wave: A pathogenetic enigma but a useful, often overlooked bedside diagnostic and prognostic clue in ischemic heart disease

Correale¹,

Battista²,

Ricciardiello³

et al. 2004

Clinical Cardiology

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Summary:The pathogenesis of U-wave inversion and its clinical value are still not clear, although the U wave was described by Einthoven together with the other electrocardiographic (ECG) waves. Not considered a useful diagnostic clue, it is not usually mentioned in ECG reports. In recent years, stimulated by the long QT syndromes and by the discovery of U-wave changes in some pathologic, mostly cardiac states, this neglected wave has attracted new interest. This review focuses on the negativity of the U wave in ischemic heart disease. The discovery of M cells and their electrophysiology has established the cellular basis for repolarization and has contributed to our knowledge of U-wave genesis. Hemodynamic changes during diastole in acute ischemia also furnish interesting elements for the interpretation of U-wave changes, and some experimental and clinical studies, besides designating stretch as a cause of U-wave changes, have also proved their value for more accurate bedside diagnosis and prognosis. They may indicate the extent of myocardial ischemia, the presence of collateral circulation, and the possible territory and vessel involved. When U-wave changes are the first and only sign of ischemia, they may contribute to a decision regarding the hospital admission of a patient without typical ischemic symptoms. Furthermore, U-wave changes during exercise tests increase their sensitivity.

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“…However, as an nU may occur also in nonischemic pathologies, these must be considered as a differential diagnosis. 10,12,13,41 These data prove the value of an nU in clinical practice.…”

Section: Discussionsupporting

confidence: 52%

Section: Pathogenesis Of the Negative U Wavementioning

confidence: 99%

Section: The Negative U Wavementioning

confidence: 99%

Section: Pathogenesis Of the Negative U Wavementioning

confidence: 99%

See 2 more Smart Citations

The negative U wave: A pathogenetic enigma but a useful, often overlooked bedside diagnostic and prognostic clue in ischemic heart disease

Correale¹,

Battista²,

Ricciardiello³

et al. 2004

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…Fu et al [7] found in hypertensive patients that handgrip-induced U wave inversion was associated with an increase in left ventricular dimension, and concluded that handgripinduced negative U waves might be caused by stretch of the ventricular wall resulting from acute left ventricular volume overload. Choo and Gibson [8] reported that a negative U wave in patients with left ventricular hyper trophy was related to abnormalities of isovolumic relax ation, and they concluded that the close relation between incoordinate relaxation and U wave inversion suggests a mechanical influence on U wave genesis.…”

Section: Correlations Between U Loop and Echocardiogrammentioning

confidence: 99%

Vector U Loop in Patients with Left Ventricular Overloading

Fujimoto¹,

Kiyoshige²,

Saito³

et al. 1988

Am J Noninvas Cardiol

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The U loops of vectorcardiograms were recorded in 30 normal subjects, 34 patients with left ventricular pressure overloading (VLPO group) whose underlying diseases were hypertensive heart disease or aortic stenosis, 42 with left ventricular volume overloading (LWO group) whose underlying diseases were aortic regurgitation or mitral regurgitation. These U loops were examined qualitatively and quantitatively, and were correlated with échocardiographie findings. In normal subjects the U loop was directed to the left, anteriorly and inferiorly, and in all cases it was inscribed counterclockwise in the horizontal plane. In both the LVPO and the LWO groups, the U loop tended to be displaced anteriorly and to the right, and was significantly greater in magnitude than that of normal subjects in the horizontal and left sagittal planes. In the mitral regurgitation group the maximum U vector was significantly greater in magnitude than that of the normal group, but no significant anterior displacement was observed. The clockwise rotation of the U loop in the horizontal plane was more frequently observed in patients with left ventricular overloading, and it was associated with the severity of the disease. There were correlations between the magnitude of the maximum U vector and left ventricular posterior wall thickness in the LVPO groups, and between the degree of anterior displacement of the U loop and left ventricular dimension in the LWO group. These findings suggest that the vector U loop is useful as clinical parameters of the hemodynamic state in the left ventricular overloading.

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Ventricular Repolarization: Theory and Practice in Non-Ischemic Myocardium

Surawicz¹

2011

Electrocardiology

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Handgrip-induced negative U-wave in electrocardiogram of hypertensive subjects.

Cited by 15 publications

References 14 publications

The negative U wave: A pathogenetic enigma but a useful, often overlooked bedside diagnostic and prognostic clue in ischemic heart disease

The negative U wave: A pathogenetic enigma but a useful, often overlooked bedside diagnostic and prognostic clue in ischemic heart disease

Vector U Loop in Patients with Left Ventricular Overloading

Ventricular Repolarization: Theory and Practice in Non-Ischemic Myocardium

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