Assessing the cause of T wave inversion in precordial leads with ECG mapping
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M Yokuşoglu1, C Sag, H Karaeren
1Department of Cardiology, Gülhane Military Medical Academy, Ankara, Turkey.
Insights
Precordial electrocardiographic (ECG) mapping accurately assesses T wave inversion in patients with angina pectoris. This method helps differentiate between coronary artery disease and normal findings, improving diagnostic accuracy.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Electrocardiography
Background:
- T wave inversion in precordial leads can indicate coronary artery disease but also occurs in healthy individuals.
- Distinguishing the cause of T wave inversion is crucial for accurate diagnosis and patient management.
Purpose of the Study:
- To evaluate the diagnostic utility of precordial electrocardiographic (ECG) mapping in assessing T wave inversion.
- To correlate ECG mapping patterns with findings from echocardiography and coronary angiography in patients with and without typical angina.
Main Methods:
- Conducted precordial ECG mapping on 51 patients, categorized into groups with atypical (Group A) and typical (Group B) symptoms.
- Correlated ECG mapping patterns (M, N, I) with echocardiography and coronary angiography results.
- Assessed diagnostic accuracy metrics including sensitivity, specificity, and positive predictive value for N and I pattern mappings.
Main Results:
- N pattern mapping demonstrated 100% sensitivity, specificity, and positive predictive value for identifying normal subjects.
- I pattern mapping showed 100% sensitivity, 90% specificity, and 90% positive predictive value for detecting coronary artery disease.
- Angiography confirmed coronary artery disease in all Group B patients with I pattern mapping and revealed normal findings in those with N pattern mapping.
Conclusions:
- Precordial ECG mapping is a highly accurate non-invasive method for assessing T wave inversion in precordial leads.
- Specific ECG mapping patterns (N and I) reliably differentiate between normal individuals and those with coronary artery disease.
Abstract:
Inversion of the T wave in precordial leads in patients with angina pectoris is a predictor of coronary disease; however, it may also be seen in normal adults. The aim of this study was to assess the cause of T wave inversion by carrying out precordial electrocardiographic (ECG) mapping in 51 patients, who also underwent echocardiography and coronary angiography. The 37 patients in group A had atypical symptoms. They included 11 patients who showed M pattern mapping, of whom 7 had noncoronary cardiac disease and 4 were normal. In 23 other group A patients, whose mappings were in the N pattern, the angiography was normal. In the remaining three patients of this group, mappings were in the I pattern, with angiography revealing coronary disease in two of them and no disease in the third. The 14 group B patients all had typical angina; mappings were in the I pattern in 8 of the patients and in the N pattern in the remaining 6. Angiography revealed coronary artery disease in all patients with the I pattern mapping, while all those with the N pattern were found to be normal. Sensitivity, specificity, and positive predictive value for detecting normal subjects were all 100% for N pattern mapping; for detecting coronary disease, they were 100%, 90%, and 90% for I pattern mapping, respectively. It is concluded that precordial ECG mapping is an accurate method for the assessment of T wave inversion in precordial leads.
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