title: Upright T wave in precordial lead V1 indicates the presence of significant coronary artery disease in patients undergoing coronary angiography with otherwise unremarkable electrocardiogram.
abstract: OBJECTIVE
  The goal of the current work was to assess the possible relationship between upright T wave in precordial lead V1 (TV1) and the occurrence of coronary artery disease (CAD) in patients undergoing coronary angiography with an otherwise unremarkable resting electrocardiogram (ECG).
  
  
  METHODS
  Twelve-lead resting ECGs of 2,468 patients who underwent coronary angiography were analyzed by independent reviewers blinded to the patients' clinical data. Patients with any condition known to affect cardiac repolarization were not eligible for inclusion.
  
  
  RESULTS
  Of 126 patients included in the study, 76 (60%) had at least one significant coronary artery stenosis. Significant CAD was more frequently found in patients with upright TV1 as compared to those with negative TV1 (74 vs. 43%, p = 0.001). Left circumflex (LCx) and left anterior descending (LAD) coronary artery lesions were more frequently observed in patients with upright TV1 than in those with inverted TV1. In univariate analysis, patients with upright TV1 were approx 4 times more likely to have significant CAD than those with inverted TV1 (odds ratio (OR) 3.7, 95% confidence interval (CI) 1.744-7.897). In addition, in the multivariate logistic regression model, upright TV1 was an independent predictor of significant CAD (OR 4.249, 95% CI 1.594-11.328), along with previous myocardial infarction (OR 17.533, 95% CI 3.338-92.091), male gender (OR 3.020; 95% CI 1.214-7.510), and age (OR 1.061; 95% CI 1.003-1.122).
  
  
  CONCLUSIONS
  It might be worthwhile to routinely evaluate the polarity of the T wave in lead V1 in patients with suspected CAD, since it appears to have additional risk stratification potential.
authors.affiliation: Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, 11080, Belgrade, Serbia. future.ivan@gmail.com
authors.forename: I
authors.initials: I
authors.lastname: Stankovic
authors.forename: K
authors.initials: K
authors.lastname: Milekic
authors.forename: A
authors.initials: A
authors.lastname: Vlahovic Stipac
authors.forename: B
authors.initials: B
authors.lastname: Putnikovic
authors.forename: M
authors.initials: M
authors.lastname: Panic
authors.forename: R
authors.initials: R
authors.lastname: Vidakovic
authors.forename: A
authors.initials: A
authors.lastname: Aleksic
authors.forename: P
authors.initials: P
authors.lastname: Milicevic
authors.forename: A N
authors.initials: AN
authors.lastname: Neskovic
mesh_terms: D017023:Coronary Angiography / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology*; D004562:Electrocardiography / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity