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Determinants of persistent negative T waves and early versus late T wave normalisation after acute myocardial
1Department of Cardiology, University Hospital, Liège, Belgium. lpierard@chu.ulg.ac.be
Insights
Early T wave normalization after myocardial infarction indicates myocardial stunning. Delayed normalization suggests ischemic myocardium, while persistent negative T waves signify necrosis or jeopardized heart muscle.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Electrocardiography
Background:
- Negative T waves following acute myocardial infarction (MI) can indicate varying degrees of myocardial damage.
- Understanding the factors influencing T wave normalization is crucial for assessing prognosis and guiding treatment.
Purpose of the Study:
- To investigate whether the timing of T wave normalization after acute myocardial infarction (MI) is determined by myocardial state, treatment, or both.
- To correlate T wave normalization patterns with myocardial viability and response to interventions.
Main Methods:
- 127 patients with acute MI and negative T waves underwent dobutamine stress echocardiography and coronary angiography.
- Electrocardiograms (ECGs) were analyzed at hospital discharge and at 4 months post-MI.
Main Results:
- T wave normalization occurred in 88 patients: early (discharge) in 19, delayed (4 months) in 69.
- Early normalization correlated with sustained contractile reserve (myocardial stunning).
- Delayed normalization and persistent negative T waves were associated with ischemic responses or persistent akinesis, with angioplasty influencing delayed normalization.
Conclusions:
- Early T wave normalization suggests myocardial stunning with recovery.
- Delayed normalization indicates ischemic myocardium, often improved by revascularization.
- Persistent negative T waves point to extensive necrosis or unrevascularized, jeopardized myocardium.
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 > or = 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.
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