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Updated: Aug 12, 2025

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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Transient decrease in the depth of the negative T wave in apical hypertrophic cardiomyopathy is a sign of left

Naoki Arima1, Yuri Ochi1, Makoto Takahashi2

  • 1Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Oko-cho, Nankoku-shi, 783-8505 Kochi, Japan.

European Heart Journal. Case Reports
|February 2, 2023
PubMed

Insights

In apical hypertrophic cardiomyopathy (HCM), a temporary decrease in negative T wave depth on ECG may signal anterior-apical ischemia due to left anterior descending artery (LAD) stenosis. This finding can revert after revascularization.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Imaging

Background:

  • Apical hypertrophic cardiomyopathy (HCM) characteristically presents with left ventricular hypertrophy (LVH) and negative T waves on electrocardiography (ECG).
  • The natural course of apical HCM can involve T wave normalization due to myocardial degeneration, but temporary T wave changes are less documented.

Observation:

  • Three patients with apical HCM and prior T wave inversion exhibited a transient reduction in negative T wave depth.
  • All observed patients had significant coronary artery stenosis, particularly in the left anterior descending artery (LAD).

Findings:

  • Following successful revascularization of the LAD lesion, the ECGs of these patients returned to their previous T wave inversion depth.
  • The temporary decrease in T wave negativity correlated with significant LAD stenosis.

Implications:

  • A transient decrease in negative T wave depth in apical HCM patients could indicate myocardial ischemia in the anterior-apical region.
  • This ECG change may serve as a potential indicator of critical LAD stenosis requiring intervention.
Abstract

Keywords:
Case seriesECGGiant negative T waveHypertrophic cardiomyopathyIschaemic heart disease

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