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Angiocardiographic findings in patients with biphasic T-wave inversion in precordial leads

Parveen Akhtar1, Syed Nadeem Hassan Rizvi, Faryal Tahir

  • 1National Institute of Cardiovascular Diseases, Karachi.

JPMA. the Journal of the Pakistan Medical Association
|July 5, 2012
PubMed

Insights

Wellen's syndrome, characterized by biphasic T-wave inversion on ECG, is linked to left anterior descending artery stenosis. Early recognition of this pattern in unstable angina can improve patient outcomes.

Area of Science:

  • Cardiology
  • Diagnostic Electrocardiography
  • Interventional Cardiology

Background:

  • Unstable angina (UA) poses significant cardiovascular risk.
  • Electrocardiogram (ECG) findings can indicate underlying coronary artery disease.
  • Wellen's syndrome, a specific ECG pattern, is associated with critical coronary artery stenosis.

Purpose of the Study:

  • To investigate the angiocardiographic findings in patients presenting with Wellen's syndrome.
  • To correlate the ECG pattern of biphasic T-wave inversion with coronary artery stenosis.
  • To assess the clinical significance of Wellen's syndrome in unstable angina.

Main Methods:

  • A descriptive, cross-sectional study included 100 consecutive patients with unstable angina and Wellen's syndrome.
  • Coronary angiography was performed to evaluate coronary artery anatomy.
  • Data on coronary risk factors and angiographic findings were collected and analyzed.

Main Results:

  • Biphasic T-wave inversion was most frequent in precordial leads V2-V3 (26%) and V2-V4 (25%).
  • Left anterior descending (LAD) artery stenosis was observed in 50% of patients (proximal) and 22% (middle segment).
  • Right coronary artery dominance was noted in 75% of patients; two-vessel disease was common.

Conclusions:

  • Wellen's syndrome is strongly associated with stenosis in the proximal and middle segments of the LAD artery.
  • This ECG pattern may be subtle during acute ischemia and could be overlooked.
  • Prompt identification and intervention for Wellen's syndrome can reduce patient morbidity and mortality.
Abstract

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