title: Prevalence and prognostic significance of T-wave inversions in right precordial leads of a 12-lead electrocardiogram in the middle-aged subjects.
abstract: BACKGROUND
  T-wave inversion in right precordial leads V(1) to V(3) is a relatively common finding in a 12-lead ECG of children and adolescents and is infrequently found also in healthy adults. However, this ECG pattern can also be the first presentation of arrhythmogenic right ventricular cardiomyopathy. The prevalence and prognostic significance of T-wave inversions in the middle-aged general population are not well known.
  
  
  RESULTS
  We evaluated 12-lead ECGs of 10 899 Finnish middle-aged subjects (52% men, mean age 44 ± 8.5 years) recorded between 1966 and 1972 for the presence of inverted T waves and followed the subjects for 30 ± 11 years. Primary end points were all-cause mortality, cardiac mortality, and arrhythmic death. T-wave inversions in right precordial leads V(1) to V(3) were present in 54 (0.5%) of the subjects. In addition, 76 (0.7%) of the subjects had inverted T waves present only in leads other than V(1) to V(3). Right precordial T-wave inversions did not predict increased mortality (not significant for all end points). However, inverted T waves in leads other than V(1) to V(3) were associated with an increased risk of cardiac and arrhythmic death (P<0.001 for both).
  
  
  CONCLUSIONS
  T-wave inversions in right precordial leads are relatively rare in the general population, and are not associated with adverse outcome. Increased mortality risk associated with inverted T waves in other leads may reflect the presence of an underlying structural heart disease.
authors.affiliation: Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, Finland. aapo.aro@helsinki.fi
authors.forename: Aapo L
authors.initials: AL
authors.lastname: Aro
authors.forename: Olli
authors.initials: O
authors.lastname: Anttonen
authors.forename: Jani T
authors.initials: JT
authors.lastname: Tikkanen
authors.forename: M Juhani
authors.initials: MJ
authors.lastname: Junttila
authors.forename: Tuomas
authors.initials: T
authors.lastname: Kerola
authors.forename: Harri A
authors.initials: HA
authors.lastname: Rissanen
authors.forename: Antti
authors.initials: A
authors.lastname: Reunanen
authors.forename: Heikki V
authors.initials: HV
authors.lastname: Huikuri
mesh_terms: D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors