Significance of the upright T wave in precordial lead V1 in adults with coronary artery disease

To determine the prevalence and evaluate the significance of an upright T wave in precordial lead V1, the 12 lead electrocardiograms of 218 patients undergoing diagnostic catheterization for the evaluation of chest pain were reviewed. Of this total, 184 patients had severe coronary artery disease (greater than or equal to 75% luminal narrowing) and 34 patients had minimal or no coronary artery disease. An upright T wave in lead V1 (greater than or equal to 0.15 mV) was present in 3 subjects (9%) without coronary artery disease; in 19 (20%) of 96 patients with one vessel disease; in 14 (27%) of 51 patients with two vessel disease and in 13 (35%) of 37 patients with three vessel disease. Among the patients with one vessel disease, an upright T wave was more frequent in patients with left circumflex artery disease than in patients with left anterior descending or right coronary artery disease (probability [p] less than 0.001). Among patients with two vessel disease, an upright T wave was more frequent in patients with disease of the right coronary and left circumflex coronary arteries than in the remaining patients (p less than 0.005). It is concluded that an upright T wave in precordial lead V1 is common in patients with isolated left circumflex artery disease but is rare in those with isolated left anterior descending artery disease. Similarly, in patients with multivessel disease, an upright T wave is common when the left circumflex artery is diseased. This finding, along with other noninvasive tests, may prove useful in patient evaluation.