The natural history of postischemic T-wave inversion: a predictor of poor short-term prognosis?

This study followed up the natural history of T-wave inversion and assessed the short-term prognosis associated with the condition.

Forty patients with acute ischemic syndrome, without infarction, and with postischemic T-wave inversion (group 1) were followed during the persistence (inverted T-wave period) and after the resolution of T-wave inversion (positive T-wave period). Another 40 patients with acute ischemic syndrome, without infarction and with normal T waves (group 2), were also followed.

Postischemic inverted T waves showed resolution within 3-21 days of presentation in 31 patients from group 1 on medical treatment alone. Further ischemic events (acute myocardial infarction, acute ischemic syndrome, angina pectoris, silent ischemia), inducible ischemia (during treadmill test), wall-motion abnormalities (demonstrated by echocardiography), all developing in the primarily ischemic myocardial area, were more frequent (P < 0.02) in group 1 patients during the inverted T-wave period compared with those experienced in the positive T-wave period of group 1 patients, and compared with group 2 patients.

In most patients on medical treatment, postischemic inverted T-waves tended to resolve within 3 weeks. The presence of postischemic inverted T waves appears to be an independent marker of further ischemic events.