title: Differences in negative T waves between acute pulmonary embolism and acute coronary syndrome.
abstract: BACKGROUND
  Patients with acute pulmonary embolism (APE) often have negative T waves (Neg T) in precordial leads at presentation, but this is also found in acute coronary syndrome (ACS) caused by left anterior descending coronary artery (LAD) disease.
  
  
  RESULTS
  Differences in Neg T on admission electrocardiograms were studied between 107 patients with APE and 248 patients with ACS caused by LAD disease. All patients had Neg T in leads V1-4 and were admitted within 7 days from symptom onset. The number of leads with Neg T (4.8±1.8 vs. 5.5±1.7, P<0.001) and maximum magnitude of Neg T (3.4±2.0 vs. 4.7±3.3mm, P<0.001) were lower in APE. The frequency of occurrence of Neg T in each of the 12 leads, and the precordial lead with the greatest Neg T (peak Neg T) differed between APE and ACS (all P<0.05, respectively). APE was strongly associated with the presence of Neg T in both leads III and V1 and peak Neg T in leads V1-2. The combination of these 2 findings identified APE with 98% sensitivity, 92% specificity, and 94% predictive accuracy, which represented the highest diagnostic accuracy.
  
  
  CONCLUSIONS
  Among patients with APE and ACS who have precordial Neg T, the presence of Neg T in leads III and V1 and/or peak Neg T in leads V1-2 simply but accurately differentiates APE from ACS.
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center.
authors.forename: Masami
authors.initials: M
authors.lastname: Kosuge
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Ebina
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hibi
authors.forename: Kengo
authors.initials: K
authors.lastname: Tsukahara
authors.forename: Noriaki
authors.initials: N
authors.lastname: Iwahashi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Umemura
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
mesh_terms: D054058:Acute Coronary Syndrome / Q000503:physiopathology*; D000368:Aged; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000503:physiopathology*; D012189:Retrospective Studies