Exercise-induced U-wave inversion as a marker of stenosis of the left anterior descending coronary artery
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Exercise-induced U-wave inversion in ECGs strongly predicts significant coronary artery disease, particularly in the proximal left anterior descending artery. This finding aids in diagnosing heart conditions non-invasively.
Area of Science:
- Cardiology
- Clinical Electrocardiography
- Diagnostic Imaging
Background:
- U-wave inversion on electrocardiograms (ECG) can indicate cardiac issues.
- The diagnostic value of exercise-induced U-wave inversion for coronary artery disease (CAD) requires further elucidation.
Purpose of the Study:
- To determine the prevalence of exercise-induced U-wave inversion.
- To identify cineangiographic correlates of this ECG finding.
- To assess its predictive value for significant CAD.
Main Methods:
- Prospective study of 248 patients undergoing exercise stress testing.
- ECG monitoring for U-wave inversion during and after exercise.
- Coronary cineangiography to assess coronary artery stenosis.
Main Results:
- Exercise-induced U-wave inversion occurred in 15% of patients (36/248).
- 35 of 36 patients with U-wave inversion had ≥75% stenosis in major coronary arteries.
- 33 patients had proximal left anterior descending or left main artery disease; 24 had no prior anterior myocardial infarction.
- Only 1.2% of patients without significant CAD showed this finding.
Conclusions:
- Exercise-induced U-wave inversion is a highly sensitive marker for significant CAD.
- It specifically indicates disease in the proximal left anterior descending coronary artery.
- This ECG pattern can be observed even with a normal resting ECG.
Abstract:
The prevalence and cineangiographic correlates of exercise-induced inversion of U waves were studied in 248 patients. Exercise-induced U-wave inversion was observed in 36 patients (15%), of whom 35 had greater than or equal to 75% stenosis in one or more of the major coronary arteries. The proximal left anterior descending or left main coronary artery was involved in 33 of these patients, including 24 patients with no electrocardiographic evidence of anterior myocardial infarction. Exercise-induced U-wave inversion was observed in the absence of an abnormal resting 12-lead ECG. Only one of the 82 patients (1.2%) without significant coronary artery disease demonstrated exercise-induced U-wave inversion, and this patient had a primary cardiomyopathy. We conclude that exercise-induced inversion of the U-wave is highly predictiveof significant coronary artery disease and, more specifically, of disease of the proximal left anterior descending coronary artery.