T wave positivity in lead aVR is associated with mortality in patients with cardiac resynchronization therapy

İçen, Yahya Kemal; Dönmez, Yurdaer; Koca, Hasan; Uğurlu, Mehmet; Koç, Mevlüt

doi:10.1007/s10840-018-0364-9

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“…In addition, lead aVR ST elevation could represent a "mirror image" of ST depression in the lateral leads, which reflects diffuse LV subendocardial ischemia (19,20). aVRT+ has been associated with unfavorable outcome in patients with an implantable cardioverterdefibrillator, heart failure with preserved LV ejection fraction, transcatheter aortic valve implantation, ischemic cardiomyopathy, and hemodialysis therapy (6,7,21,22,23).…”

Section: Discussionmentioning

confidence: 99%

“…The T wave in lead aVR is normally negative due to the unique location of this augmented extremity lead. However, previous studies have shown that a positive or isoelectric T wave (aVRT+) in a routine 12-lead ECG is an independent prognostic predictor of cardiovascular mortality in the general population as well as in cardiovascular disease (1)(2)(3)(4)(5)(6)(7)(8). Changes in lead aVR are also important in the differential diagnosis of tachyarrhythmias (9).…”

Section: Introductionmentioning

confidence: 99%

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The prognostic significance of a positive or isoelectric T wave in lead aVR in patients with acute coronary syndrome and ischemic ECG changes in the presenting ECG - Long-term follow-up data of the TACOS study

Siren

Koivula

Eskola

et al. 2020

Journal of Electrocardiology

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Background. A positive T wave in lead aVR (aVRT+) is an independent prognostic predictor of cardiovascular mortality in the general population as well as in cardiovascular disease.Subjects and Methods. We evaluated the prognostic impact of aVRT+ in an ECG recorded as close to hospital discharge as possible in acute coronary syndrome patients (n=527). We divided the patients into three categories based on the findings in the admission ECG: ST elevation, global ischemia and other ST/T changes.Results. In the whole study population, and in all the three ECG subgroups, the 10-year all-cause mortality rate was higher in the aVRT+ group than in the aVRT-group. In Cox regression analysis, the age and gender adjusted hazard ratio (HR) for aVRT+ to predict all-cause mortality in the whole study population was 1.43 (95% confidence interval [CI] 1.12-1.83; p=0.004). To predict cardiovascular mortality, the age and gender adjusted HR for aVRT+ was 1.54 (95% CI 1.14-2.07; p=0.005) in the whole study population and 2.07 (95% CI 1.07-4.03; p=0.032) in the category with other ST/T changes. Conclusion.In ACS patients with or without ST elevation, but with ischemic ST/T changes in their presenting ECG, a positive or isoelectric T wave in lead aVR in an ECG recorded in the subacute in-hospital stage is associated with all-cause and cardiovascular mortality during long-term follow-up. Clinicians should pay attention to this simple ECG finding at hospital discharge.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The prognostic significance of a positive or isoelectric T wave in lead aVR in patients with acute coronary syndrome and ischemic ECG changes in the presenting ECG - Long-term follow-up data of the TACOS study

Siren

Koivula

Eskola

et al. 2020

Journal of Electrocardiology

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T wave positivity in lead aVR is associated with mortality in patients with cardiac resynchronization therapy

Abstract: In CRT-D patients, a positive TPaVR in surface ECG may be a strong mortality indicator.

Cited by 1 publication

References 23 publications

The prognostic significance of a positive or isoelectric T wave in lead aVR in patients with acute coronary syndrome and ischemic ECG changes in the presenting ECG - Long-term follow-up data of the TACOS study

The prognostic significance of a positive or isoelectric T wave in lead aVR in patients with acute coronary syndrome and ischemic ECG changes in the presenting ECG - Long-term follow-up data of the TACOS study

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