Myocardial damage and left ventricular dysfunction in patients with and without persistent negative T waves after Q-wave anterior myocardial infarction

Persistent T-wave inversions during the chronic stage of CS-wave myocardial infarction (MI) indicate the presence of a transmural infarction with a fi brotic layer pathologically. The aim of the present study was to examine th e relation between left ventricular (LV) damage and changes in polarity of the T waves from the acute to chronic phase in patients with Q-wave anterio r wall MI. We studied 140 patients with persistent T-wave inversions in lea ds with Q waves (negative T-wave group) and 158 patients with positive T wa ves (positive T-wave group) at 12 months after anterior MI. In the positive T-wave group, the precordial T waves reverted from a negative to a positiv e morphology <3 months after MI in 21 patients (3 M-positive T-wave subgrou p), 3 to 6 months in 52 patients (6 M-positive T-wave subgroup), and 6 to 1 2 months in 75 patients (12 M-positive T-wave subgroup). Ten patients had p ersistent positive T waves without initial T-wave inversion (persistent pos itive T-wave group). Wall motion index and LV dimension were higher and the wall thickness for the infarct area and LV ejection fraction were lower in the negative T-wave than in the positive T-wave groups, except the persist ent positive T-wave group in the chronic stage (p <0.0001). Wall motion in the infarcted area improved over the course of 1 year in the 3 M-, 6 M-, an d 12 M-positive T-wave subgroups (p <0.0001), but not in the persistent pos itive T-wave group. Among the patients with T-wave inversions after admissi on, those who had persistent negative T waves after 12 months had worse LV function. In patients with initial T-wave inversion, earlier normalization of the precardial T waves was associated with greater improvement in LV fun ction. Patients with persistent positive T waves without initial negative T waves had poorer recovery of LV function than patients with persistent neg ative T waves. We conclude that the presence of inverted T waves in leads w ith abnormal Q waves 12 months after MI and the time required for T-wave no rmalization can be used to assess the degree of LV dysfunction. (C) 2001 by Excerpta Medica, Inc.