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

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

[Postischemic inverted T waves: does gradual regression indicate improved prognosis?]. / A postischaemiás invertált T hullámok természetrajza: a fokozatos megszünés javuló prognózist jelent?

This study has followed up the natural history of postischemic inverted T waves and assessed the prognosis. 40 consecutive patients with unstable angina with postischemic precordial inverted T waves in the noninfarcted, previously ischemic area were followed during the persistence (negative T wave period) and after resolution of inverted T waves (positive T wave period). The outcome with frequencies of acute myocardial infarction, acute ischemic syndrome, angina pectoris, positive exercise test, silent myocardial ischemia, anterior wall motion abnormalities on echocardiogram, positive coronary arteriography were determined and compared in the negative versus positive T wave periods. Postischemic inverted T waves showed resolution within the postischemic 3-21 days (at a mean of 10.6 days) in 31 patients on medical treatment alone during the whole study period. Frequencies of parameters/patients determined in negative versus positive T wave periods are as follows: acute myocardial infarction: 5/40 versus 0/31 (non significant), acute ischemic syndrome: 25/40 versus 2/31 (p < 0.001), angina pectoris: 32/40 versus 11/31 (p < 0.001), positive treadmill exercise test: 14/16 versus 14/30 (p < 0.02), silent myocardial ischemia: 14/14 versus 16/31 (p < 0.01), hypokinesis 26/34 versus 4/24 (p < 0.001), positive coronary arteriography: 4/4 versus 11/11 (non significant). In most patients on medical treatment, the postischemic inverted T waves tend to resolve within 3 weeks. Attention has to be paid to the patients with postischemic inverted T waves during the negative T wave period: the high ischemic risk gradually decreases with resolution of negative T waves.