title: Associations between different status of myocardial ischemia and ischemia-related negative or positive epicardial U-waves: observations during coronary angioplasty.
abstract: This study examined the relationships between the polarity of the U wave on intracoronary electrocardiogram (ECG) and the status of myocardial ischemia during angioplasty. The ECG features of ischemia-related U waves were also evaluated. Among 63 patients with intracoronary ECGs adequate for analysis of U waves, there were 26 patients showing a change of the U wave to a negative direction and 18 patients showing a change to a positive direction from baseline to coronary occlusion. Among these patients, 10 of the former showed a distinct change in polarity of the U wave from positive to negative (group A), and 7 of the latter patients showed the opposite change (group B). Patients in group B had a higher incidence of prior myocardial infarction (86% vs 30%; P < .05), presence of an abnormal Q wave on intracoronary ECG (71% vs 20%; P < .05), poor wall motion in the angioplasty-related area (100% vs 30%; P < .01), and lower left ventricular ejection fraction (55.7% +/-8.1% vs 66.6% +/- 4.5%; P < .01) than patients in group A. The remaining patients (other than groups A and B) showing U wave change in a negative (n = 16) or positive (n = 11) direction presented with similar features to those in groups A or B, respectively. The ECG features of several types of ischemia-related U wave were determined by analysis of intracoronary ECG obtained from the patients in groups A and B. In group A, the Bazett-corrected Q (positive U) interval measured at baseline (myocardial state; near normal) was significantly shorter than the Q-(negative U) interval measured during coronary occlusion (acute ischemia) (0.518 +/- 0.031 s vs 0.579 +/- 0.046 s; P < .01). In group B, the Q-(negative U) interval measured at baseline (chronic ischemia) was longer than the Q-(positive U) interval measured during angioplasty (acute-on-chronic ischemia) (0.582 +/- 0.034 s vs 0.501 +/- 0.027 s; P < .001). Thus, intracoronary ECG recorded during angioplasty in the present study revealed physiologic U wave, two types ("acute" and "chronic") of ischemia-related negative and one type ("pseudonormal") of ischemia-related positive U waves, each of which appeared in a different status of myocardial ischemia and possessed characteristic ECG features in its appearance.
authors.affiliation: Internal Medicine, Nishida Hospital, Saiki-city, Oita, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kataoka
authors.forename: S
authors.initials: S
authors.lastname: Yano
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003326:Coronary Circulation / Q000502:physiology*; D003331:Coronary Vessels / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D010496:Pericardium / Q000503:physiopathology; D011379:Prognosis; D016277:Ventricular Function, Left / Q000502:physiology