THE DEEPER THE NEGATIVITY OF THE T-WAVES RECORDED, THE GREATER IS THEEFFECTIVENESS OF REPERFUSION OF THE MYOCARDIUM

We evaluated the time course of QT intervals and the amplitude of T wa ves, and their relationship to subsequent left ventricular regional wa ll motions in 88 patients with successfully reperfused acute myocardia l infarction (MI). The QTc intervals and the amplitude of inverted T w aves of lead V-3 in patients with anterior MI and of lead III in patie nts with inferior MI were measured for 1 month after MI. Patients were classified as having severe T wave inversion or mild T wave inversion within 3 days of MI, based on a measurement of 0.5 mV in the anterior MI cases and 0.3 mV in the inferior MI cases, Chronic-phase left vent riculography was performed 5 months later, and hypokinesis of the infa rct site was measured using the centerline method. The T waves inverte d after reperfusion in 86 patients (98%). The inverted T waves deepene d twice, with the first negative peak about 48 h and the second negati ve peak about 18 days after MI. QTc intervals became prolonged as the T waves deepened. The extent of hypokinesis in the chronic phase corre lated with the amplitude of inverted T waves and QTc intervals when th e T waves were deepest. The group with severe T wave inversion had les s extensive hypokinesis, a lower maximum serum creatine kinase level a nd a shorter time to reperfusion from the onset of symptoms than the g roup with mild inversion. We conclude that the degree of T wave invers ion 48 h after MI is predictive of abnormalities in left ventricular r egional wall motions in the chronic phase. A deep inverted T wave in t he acute phase of MI indicates an abundantly stunned myocardium.