T-wave changes in patients with hemodynamic evidence of systolic or diastolic overload of the left ventricle: a retrospective study on 168 patients with isolated chronic aortic valve disease.
The effect of systolic and diastolic overload of the left ventricle on the T wave was studied in 86 patients with pure aortic stenosis and in 82 patients with pure aortic insufficiency documented by hemodynamic investigation. All patients had hemodynamically significant, chronic isolated aortic valve disease with electrocardiographic evidence of left ventricular hypertrophy (Sokolow index greater than or equal to 45 mm). All had undergone selective coronary angiography. Flattened or negative T waves were present in 44 patients with aortic stenosis (51%) and in 66 (80%) with aortic incompetence. Inversion of the T wave in left ventricular leads was unrelated to the presence of ventricular conduction disturbances or to coronary artery disease or to low cardiac index. It was significantly related to older age (P = 0.0001) and, in patients with aortic incompetence, to the end-diastolic volume (P = 0.04). Digitalis intake was a nonsignificant (P = 0.10) independent variable. These findings suggest that patients with aortic stenosis cannot be distinguished from patients with aortic incompetence by the electrocardiogram and that the theory of Cabrera and Monroy is not valid in this set of patients.
D000328:Adult; D001022:Aortic Valve Insufficiency / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000503:physiopathology*; D006332:Cardiomegaly / Q000503:physiopathology; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies