CLINICAL IMPLICATIONS OF ISOLATED T-WAVE INVERSION IN ADULTS - ELECTROCARDIOGRAPHIC DIFFERENTIATION OF THE UNDERLYING CAUSES OF THIS PHENOMENON

Objectives. This study aimed to assess the causes and clinical implica tions of isolated T wave inversion in adults and to evaluate electroca rdiographic (ECG) differentiation of these causes. Background. There a re few previous reports on isolated T wave inversion in adults, which is a paradoxic observation in normal adults and in those with severe c oronary artery disease. Methods. We used echocardiography, stress thal lium-201 scintigraphy and coronary angiography to determine the underl ying causes and then used conventional electrocardiography and precord ial ECG mapping to differentiate them. Eighty-six consecutive patients with isolated T wave inversion were classified as follows: group A in cluded 23 asymptomatic patients; group B included 63 patients with che st pain. Results. In group A, isolated T wave inversion was found as a normal variant in 20 patients and was due to hypertrophic cardiomyopa thy in 3. In group B, the cause was hypertrophic cardiomyopathy in 3 p atients, pericarditis in 2, coronary artery disease (lesions of the pr oximal left anterior descending coronary artery) in 39 and a normal va riant 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, precord ial ECG mapping demonstrated excellent detection of coronary artery di sease, with a sensitivity, specificity and overall accuracy of 88%, 93 % and 91%, respectively. Conclusions. Isolated T wave inversion in asy mptomatic adults is usually a normal variant. In patients with chest p ain, isolated T wave inversions can develop in two different situation s: a normal variant and severe coronary artery disease; these can be e asily differentiated by precordial ECG mapping using conventional elec trocardiography.