Isolated T Wave Inversion in Lead aVL: An ECG Survey and a Case Report

Abstract

Background. Computerized electrocardiogram (ECG) analysis has been of tremendous help for noncardiologists, but can we rely on it? The importance of ST depression and T wave inversions in lead aVL has not been emphasized and not well recognized across all specialties. Objective. This study's goal was to analyze if there is a discrepancy of interpretation by physicians from different specialties and a computer-generated ECG reading in regard to a TWI in lead aVL. Methods. In this multidisciplinary prospective study, a single ECG with isolated TWI in lead aVL that was interpreted by the computer as normal was given to all participants to interpret in writing. The readings by all physicians were compared by level of education and by specialty to one another and to the computer interpretation. Results. A total of 191 physicians participated in the study. Of the 191 physicians 48 (25.1%) identified and 143 (74.9%) did not identify the isolated TWI in lead aVL. Conclusion. Our study demonstrated that 74.9% did not recognize the abnormality. New and subtle ECG findings should be emphasized in their training so as not to miss significant findings that could cause morbidity and mortality.

Value of electrocardiographic T wave inversion in lead aVL in prediction of Mid Left Anterior Descending Stenosis in patients with stable Coronary Artery disease

“…The remaining 191 patients constituted the study population and found that T wave inversion in aVL was found to be the only ECG variable signi icantly predicting mid segment (LAD) lesions (Odds Ratio 2.93, 95% Con idence Interval 1.59-5.37, p=0.001. which is totally in agreement to our study , also Hassen GW et al [22]. In a multidisciplinary prospective study, a single ECG with isolated T wave inversion in lead aVL that was interpreted by the computer as normal was given to all participants to interpret in writing.…”

Does T wave inversion in lead aVL predict mid-segment left anterior descending lesions in acute coronary syndrome? A retrospective study

“…Moreover, previous studies reported that approximately 75% of physicians missed an isolated T wave inversion in lead aVL and that the best single lead for the emergency detection of ACS was lead aVL. 12 13 In agreement with this literature, our findings underscore the importance of cautious interpretation of T wave inversion in lead aVL as a clue to predict ischaemic lesions in ACS.…”

“…The reasons for the disparities in the diagnostic values among studies are likely multifactorial. First, although the definition of T wave inversion was unclear in previous studies, 5 6 12 we clearly defined T wave inversion according to the AHA definition; 9 therefore, our findings were less likely to be subject to information bias. Second, a previous study used a combination of T wave inversion in lead aVL and lead I to estimate the diagnostic values.…”

“… 3 To date, several studies have focused on the diagnostic values of T wave inversion for predicting MLAD lesions. 4 5 12 Among patients with chronic stable angina, the OR of T wave inversion in lead aVL for predicting MLAD lesions was 2.93. 5 In another study, T wave inversion in leads aVL and I had a sensitivity of 86.5% and specificity of 55.6% for predicting MLAD lesions.…”

Electrocardiographic clue for a mid-LAD lesion

“…In a study by Hassen et al ,6 an ECG, including isolated T-wave inversion in lead aVL, was shown to 191 doctors, and 143 of them (74.9%) interpreted it as normal.…”