Negative T waves shortly after ST-elevation acute myocardial infarction are a powerful marker for improved survival rate

Sgarbossa, Elena B.; Meyer, Peter; Pinski, Sergio L.; Pavlovic-Surjancev, Biljana; Barbagelata, Alejandro; Goodman, Shaun G.; Lum, Andrea; Underwood, Donald A.; Gates, Kathy; Califf, Robert M.; Topol, Eric J.; Wagner, Galen S.

doi:10.1067/mhj.2000.108835

Cited by 24 publications

(11 citation statements)

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“…26,27 The development, dynamic changes, and resolution of the Wellens' ECG pattern was subsequently observed in a variety of other conditions, all characterized by a reversible LV dysfunction ("stunned myocardium"), by either ischemic or nonischemic causes, including TTC. [28][29][30][31][32] The latter condition represent an ideal clinical model for investigating the electrogenetic basis of "ischemic-like" T-wave inversion/QT interval prolongation and life-threatening ventricular arrhythmias in the setting of stunned myocardium.…”

Section: Dynamics Of Ecg Abnormalities In Ttcmentioning

confidence: 99%

Myocardial edema as a substrate of electrocardiographic abnormalities and life-threatening arrhythmias in reversible ventricular dysfunction of takotsubo cardiomyopathy: Imaging evidence, presumed mechanisms, and implications for therapy

et al. 2015

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Section: Dynamics Of Ecg Abnormalities In Ttcmentioning

confidence: 99%

Myocardial edema as a substrate of electrocardiographic abnormalities and life-threatening arrhythmias in reversible ventricular dysfunction of takotsubo cardiomyopathy: Imaging evidence, presumed mechanisms, and implications for therapy

et al. 2015

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“…18,19) Normalization of the ST segment has been reported as an important marker of reperfusion after thrombolytic therapy. Patients experiencing their first acute infarction treated with thrombolysis who have negative T waves beyond 24-48 hours after admission in ECG leads with initial ST elevation, have higher 30 day survival rates than patients without negative T waves.…”

Section: Discussionmentioning

confidence: 99%

Predischarge ST Segment and T Wave Patterns in Predicting Left Ventricular Function and Myocardial Viability in Q Wave Anterior Myocardial Infarction Patients

2005

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SUMMARYThe aim of this study was to investigate the correlation between ECG changes prior to discharge and findings of early low dose dobutamine stress echocardiography (LDSE) performed in 6 ± 2 days, in patients experiencing their first acute anterior MI.A total of 62 patients admitted with their first acute anterior MI were divided into three groups according to the findings of electrocardiograms performed on the 7-10th days: group A, isoelectric ST and negative or positive T wave; group B, ST elevation (> 0.1 mV) and negative T wave; and group C, ST elevation and positive T wave.There were no significant differences between the groups with respect to thrombolytic therapy and reperfusion criteria. In addition, 90% of the patients in group A (20/22), 66% in group B (12/18, P < 0.05 versus group A), and only 54% in group C (12/22, P < 0.01 versus group A) responded to LDSE. The infarct zone wall motion score index (WMSI) measured by LDSE was significantly decreased in group A compared to basal values (from 2.71 ± 0.65 to 2.07 ± 0.71 P = 0.02), and it was significantly different compared to groups B and C. Moreover, the serum creatinine kinase level of the patients in group C was higher (P < 0.01 versus group A), whereas the ejection fraction was inferior (group A 48%, group B 47%, and group C 41%, P = 0.04 versus group A). When the correlations between good left ventricular function and terminal QRS distortion, sum ST elevation, the number of leads with ST elevation, ST elevation shape on admission, and ST and T alterations in ECG at discharge were investigated, an independent correlation was found between ST and T alteration in ECG and a WMSI value < 2 at rest or after LDSE (P = 0.03, OR 3.08, 95%CI 1. 05-8.98).At the infarct zone of patients with ST elevation and positive T waves, left ventricular function is worse and the viability is less. This simple classification may be useful in predicting left ventricular function at the time of discharge. (Int Heart J 2005; 46: 961-973)

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“…T wave normalisation corresponded to abnormal negative T waves becoming positive or isoelectric in > 2 infarct related leads either at hospital discharge (early) or on the four month ECG (delayed). [4][5][6] Dobutamine stress echocardiography b Adrenergic blocking agents were withdrawn 48 hours before the study. Dobutamine was infused at incremental doses of 5-40 mg/kg/min at three minute intervals.…”

Section: Ecg Analysismentioning

confidence: 99%

“…Negative T waves early after thrombolysis are associated with patency of the infarct related artery, mild to moderate residual stenosis, and preserved left ventricular function [1][2][3] and are an independent predictor of one month survival. 4 In contrast, negative T waves were a predictor of death in long term studies analysing patients who survived three to four months after acute myocardial infarction. 5 6 These contradictory observations probably relate to differing characteristics of persistent negative T waves as opposed to reversible negative T waves that normalise over time.…”

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confidence: 98%

Determinants of persistent negative T waves and early versus late T wave normalisation after acute myocardial infarction

Piérard

Lancellotti

2005

Heart

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Objective: To determine whether persistent versus early or delayed T wave normalisation of negative T waves after acute myocardial infarction is determined by the myocardial state, the treatment strategy, or both. Design: 127 consecutive patients with a first acute myocardial infarction and > 2 negative T waves on the 24-36 hour ECG were studied. They underwent dobutamine stress echocardiography and coronary angiography during the first week. ECG was recorded at hospital discharge and at a mean (SD) of 4 (1) months. Setting: University hospital. Results: T wave normalisation was observed in 88 patients (early at discharge in 19 and delayed at four months in 69). Early T wave normalisation was associated with sustained contractile reserve during dobutamine stress (13 of 19 (68%)), whereas delayed T wave normalisation was observed mainly in patients with an ischaemic response (49 of 69 (71%)). The persistence of negative T waves was associated with an ischaemic response (21 of 39 (54%)) or persistent akinesis (17 of 39 (44%)). Among patients with an ischaemic response to dobutamine, in-hospital elective angioplasty was an independent determinant of delayed T wave normalisation (39 of 49 v 4 of 21 patients with persistent negative T waves at four months, p , 0.0001). Conclusions: Early T wave normalisation is associated with dobutamine induced, sustained improvement indicating myocardial stunning. Delayed normalisation is observed mainly in patients with ischaemic myocardium who have undergone revascularisation. Persistent negative T waves correspond to either extensive necrosis or non-revascularised, jeopardised myocardium.T he clinical significance of negative T waves after acute myocardial infarction is controversial. Negative T waves early after thrombolysis are associated with patency of the infarct related artery, mild to moderate residual stenosis, and preserved left ventricular function [1][2][3] and are an independent predictor of one month survival. 4 In contrast, negative T waves were a predictor of death in long term studies analysing patients who survived three to four months after acute myocardial infarction. 6These contradictory observations probably relate to differing characteristics of persistent negative T waves as opposed to reversible negative T waves that normalise over time. Spontaneous normalisation of negative T waves is a marker of myocardial viability 7 8 and predicts recovery of regional dysfunction. 10Functional recovery is greater in the presence of early T wave normalisation. 11 Persistent negative T waves have been found to be associated with transmural necrosis.12 Accordingly, we hypothesised that persistent versus early or delayed normalisation of negative T waves after a first acute myocardial infarction are determined by the myocardial state, the treatment strategy, or both. METHODS Patient selectionThe study population consisted of 127 consecutive patients prospectively enrolled with the following inclusion criteria: diagnosis of acute myocardial infarction (typical chest pain >...

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Negative T waves shortly after ST-elevation acute myocardial infarction are a powerful marker for improved survival rate

Cited by 24 publications

References 44 publications

Myocardial edema as a substrate of electrocardiographic abnormalities and life-threatening arrhythmias in reversible ventricular dysfunction of takotsubo cardiomyopathy: Imaging evidence, presumed mechanisms, and implications for therapy

Myocardial edema as a substrate of electrocardiographic abnormalities and life-threatening arrhythmias in reversible ventricular dysfunction of takotsubo cardiomyopathy: Imaging evidence, presumed mechanisms, and implications for therapy

Predischarge ST Segment and T Wave Patterns in Predicting Left Ventricular Function and Myocardial Viability in Q Wave Anterior Myocardial Infarction Patients

Determinants of persistent negative T waves and early versus late T wave normalisation after acute myocardial infarction

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