Clinical implications of isolated T wave inversion in adults: electrocardiographic differentiation of the underlying causes of this phenomenon

Second Department of Internal Medicine, School of Medicine, Kyorin University, Tokyo, Japan.

OBJECTIVES. This study aimed to assess the causes and clinical implications of isolated T wave inversion in adults and to evaluate electrocardiographic (ECG) differentiation of these causes. BACKGROUND. There are few previous reports on isolated T wave inversion in adults, which is a paradoxic observation in normal adults and in those with severe coronary artery disease. METHODS. We used echocardiography, stress thallium-201 scintigraphy and coronary angiography to determine the underlying causes and then used conventional electrocardiography and precordial ECG mapping to differentiate them. Eighty-six consecutive patients with isolated T wave inversion were classified as follows: group A included 23 asymptomatic patients; group B included 63 patients with chest pain. RESULTS: In group A, isolated T wave inversion was found as a normal variant in 20 patients and was due to hypertrophic cardiomyopathy in 3. In group B, the cause was hypertrophic cardiomyopathy in 3 patients, pericarditis in 2, coronary artery disease (lesions of the proximal left anterior descending coronary artery) in 39 and a normal variant in 19. The causes of isolated T wave inversion were difficult to determine from 12-lead ECG findings alone. However, when the inverted T wave region extended into the upper part of the precordium, precordial ECG mapping demonstrated excellent detection of coronary artery disease, with a sensitivity, specificity and overall accuracy of 88%, 93% and 91%, respectively. CONCLUSIONS: Isolated T wave inversion in asymptomatic adults is usually a normal variant. In patients with chest pain, isolated T wave inversions can develop in two different situations: a normal variant and severe coronary artery disease; these can be easily differentiated by precordial ECG mapping using conventional electrocardiography.

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