The Neglected Lead on Electrocardiogram: T Wave Inversion in Lead aVL, Nonspecific Finding or a Sign for Left Anterior Descending Artery Lesion?
| Autor: | Justin Seashore, Alice Chen, Hossein Kalantari, Shakeel Usmani, Getaw Worku Hassen, Ana Costea, Bahareh Soroori-Rad, Hafiz Hussein, Sonia Vaidian, Tennyson Smith, Wei Sun, Edris Alderwish, George Fernaine, Bonnie Simmons, Claire Carrazco |
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| Rok vydání: | 2014 |
| Předmět: |
Male
Coronary angiography Acute coronary syndrome medicine.medical_specialty Coronary Artery Disease Sensitivity and Specificity Lesion Electrocardiography Predictive Value of Tests T wave Internal medicine medicine Humans In patient cardiovascular diseases Myocardial infarction Acute Coronary Syndrome Aged Retrospective Studies Likelihood Functions Electrocardiogram T wave business.industry Middle Aged medicine.disease medicine.anatomical_structure Emergency Medicine Cardiology Female medicine.symptom business Artery |
| Zdroj: | The Journal of Emergency Medicine. 46:165-170 |
| ISSN: | 0736-4679 |
| DOI: | 10.1016/j.jemermed.2013.08.079 |
| Popis: | The electrocardiogram (ECG) is the most important diagnostic tool for acute myocardial infarction (AMI). T wave inversion (TWI) in lead aVL has not been emphasized or well recognized.This study examined the relationship between the presence of TWI before the event and mid-segment left anterior descending (MLAD) artery lesion in patients with AMI.Retrospective charts of patients with acute coronary syndrome between the months of January 2009 and December 2011 were reviewed. All patients with MLAD lesion were identified and their ECG reviewed for TWI in lead aVL.Coronary angiography was done on 431 patients. Of these, 125 (29%) had an MLAD lesion. One hundred and six patients (84.8%) had a lesion50% and 19 patients (15.2%) had a lesion50%. Of the 106 patients who had a MLAD lesion50%, 90 patients (84.9%) had TWI in lead aVL and one additional lead. Of the 19 patients who had an MLAD lesion50%, 8 patients (42.1%) had TWI in lead aVL and one additional lead. Isolated TWI in lead aVL had an overall sensitivity of 76.7% (95% confidence interval [CI] 0.65-0.86), a specificity of 71.4% (95% CI 0.45-0.88), a positive predictive value of 92%, a negative predictive value of 41.7%, a positive likelihood ratio of 2.7 (95% CI 1.16-6.22), and negative likelihood ratio of 0.32 (95% CI 0.19-0.58) for predicting a MLAD lesion of50% (p = 0.0011).TWI in lead aVL might signify a mid-segment LAD lesion. Recognition of this finding and early appropriate referral to a cardiologist might be beneficial. Additional studies are needed to validate this finding. |
| Databáze: | OpenAIRE |
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