title: Does T wave inversion in lead aVL predict mid-segment left anterior descending lesions in acute coronary syndrome? A retrospective study.
abstract: OBJECTIVE
  Limited data are available regarding the predictive value of electrocardiographic T wave inversion in lead aVL for mid-segment left anterior descending (MLAD) lesions among patients with acute coronary syndrome (ACS).
  
  
  METHODS
  Retrospective single-centre study, using a prospectively-collected coronary angiography database from January 2012 to December 2013.
  
  
  METHODS
  We included consecutive adult patients with ACS who underwent urgent percutaneous coronary intervention (PCI) within 24 h after arriving at the hospital. We excluded patients who did not undergo an ECG before PCI, patients with proximal MLAD occlusion and patients diagnosed with vasospastic angina.
  
  
  METHODS
  The primary outcome was MLAD lesion >50%. The other outcome of interest was MLAD lesion as a cause of ACS. First, we evaluated the diagnostic values of T wave inversion in lead aVL regardless of other T wave changes for each outcome. Second, we evaluated the diagnostic values of isolated T wave inversion in lead aVL.
  
  
  RESULTS
  Overall, 219 patients were eligible for the analysis. T wave inversion in lead aVL regardless of other T wave changes had a sensitivity of 32.9%, specificity of 48.2%, positive predictive value of 27.6% and negative predictive value of 54.5% for predicting MLAD lesions. Isolated T wave inversion in lead aVL had a sensitivity of 9.8%, specificity of 86.9%, positive predictive value of 30.8% and negative predictive value of 61.7% for predicting MLAD lesions. These diagnostic values did not change materially when focusing on patients with MLAD lesion as the cause.
  
  
  CONCLUSIONS
  While T wave inversion in lead aVL regardless of other T wave changes had low diagnostic values for predicting MLAD lesions, isolated T wave inversion in lead aVL had a high specificity. Our inferences underscore the importance of a cautious interpretation of T wave inversion in lead aVL among patients with ACS.
authors.affiliation: Department of Cardiology, Ise Red Cross Hospital, Mie, Japan.
authors.forename: Nobuto
authors.initials: N
authors.lastname: Nakanishi
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Goto
authors.affiliation: Department of Cardiology, Ise Red Cross Hospital, Mie, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Ikeda
authors.affiliation: Department of Cardiology, Ise Red Cross Hospital, Mie, Japan.
authors.forename: Atsunobu
authors.initials: A
authors.lastname: Kasai
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D000368:Aged; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: T wave inversion; acute coronary syndrome; electrocardiography; left anterior descending lesion
references.citation: Oman Med J. 2010 Apr;25(2):124-7
references.pmid: 22125714
references.citation: J Emerg Med. 2014 Feb;46(2):165-70
references.pmid: 24286713
references.citation: Emerg Med Int. 2015;2015:250614
references.pmid: 25949826
references.citation: J Electrocardiol. 1990 Jul;23(3):191-8
references.pmid: 2384724
references.citation: Circulation. 1975 Apr;51(4 Suppl):5-40
references.pmid: 1116248
references.citation: Circulation. 2009 Mar 17;119(10):e241-50
references.pmid: 19228821
references.citation: Am J Emerg Med. 2002 May;20(3):252-62
references.pmid: 11992349
references.citation: Am Heart J. 1996 Jan;131(1):38-42
references.pmid: 8554017
references.citation: J Electrocardiol. 2007 Jul;40(3):251-6
references.pmid: 17292385
references.citation: Am J Emerg Med. 2014 Jul;32(7):785-8
references.pmid: 24792939
references.citation: N Engl J Med. 2009 May 21;360(21):2165-75
references.pmid: 19458363
references.citation: Am J Cardiol. 1993 Jun 1;71(15):1359-62
references.pmid: 8498382
references.citation: N Engl J Med. 2003 Mar 6;348(10):933-40
references.pmid: 12621138
references.citation: Circulation. 2013 Jan 29;127(4):e362-425
references.pmid: 23247304