CARDIOVASCULAR MEDICINE

Determinants of persistent negative T waves and early versus late T wave normalisation after acute myocardial infarction

L A Pierard, P Lancellotti

Department of Cardiology, University Hospital, Liège, Belgium

Correspondence to:
Correspondence to:
Professor Luc A Pierard
Department of Cardiology, University Hospital of Liège, B-4000 Liege, Belgium; lpierard{at}chu.ulg.ac.be

Objective: To determine whether persistent versus early or delayed T wave normalisation of negative T waves after acute myocardial infarction is determined by the myocardial state, the treatment strategy, or both.

Design: 127 consecutive patients with a first acute myocardial infarction and 2 negative T waves on the 24–36 hour ECG were studied. They underwent dobutamine stress echocardiography and coronary angiography during the first week. ECG was recorded at hospital discharge and at a mean (SD) of 4 (1) months.

Setting: University hospital.

Results: T wave normalisation was observed in 88 patients (early at discharge in 19 and delayed at four months in 69). Early T wave normalisation was associated with sustained contractile reserve during dobutamine stress (13 of 19 (68%)), whereas delayed T wave normalisation was observed mainly in patients with an ischaemic response (49 of 69 (71%)). The persistence of negative T waves was associated with an ischaemic response (21 of 39 (54%)) or persistent akinesis (17 of 39 (44%)). Among patients with an ischaemic response to dobutamine, in-hospital elective angioplasty was an independent determinant of delayed T wave normalisation (39 of 49 v 4 of 21 patients with persistent negative T waves at four months, p < 0.0001).

Conclusions: Early T wave normalisation is associated with dobutamine induced, sustained improvement indicating myocardial stunning. Delayed normalisation is observed mainly in patients with ischaemic myocardium who have undergone revascularisation. Persistent negative T waves correspond to either extensive necrosis or non-revascularised, jeopardised myocardium.

Keywords: dobutamine; echocardiography; electrocardiography; myocardial infarction; percutaneous transluminal coronary angioplasty

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Pierard, L A (2007). ST elevation after myocardial infarction: what does it mean?. Heart 93: 1329-1330 [Abstract] [Full Text]  
• Strom Moller, C., Zethelius, B., Sundstrom, J., Lind, L. (2007). Persistent ischaemic ECG abnormalities on repeated ECG examination have important prognostic value for cardiovascular disease beyond established risk factors: a population-based study in middle-aged men with up to 32 years of follow-up. Heart 93: 1104-1110 [Abstract] [Full Text]