Hyperacute T Wave in the Early Diagnosis of Acute Myocardial Infarction.

Koechlin, Luca; Strebel, Ivo; Zimmermann, Tobias; Nestelberger, Thomas; Walter, Joan; Lopez-Ayala, Pedro; Boeddinghaus, Jasper; Shrestha, Samyut; Arslani, Ketina; Stefanelli, Sabrina; Reuthebuch, Benedikt; Wussler, Desiree; Ratmann, Paul David; Christ, Michael; Badertscher, Patrick; Wildi, Karin; Giménez, Maria Rubini; Gualandro, Danielle M; Miró, Òscar; Fuenzalida, Carolina; ... (2023). Hyperacute T Wave in the Early Diagnosis of Acute Myocardial Infarction. Annals of emergency medicine, 82(2), pp. 194-202. Elsevier 10.1016/j.annemergmed.2022.12.003

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STUDY OBJECTIVE

The diagnostic performance of T-wave amplitudes for the detection of myocardial infarction is largely unknown. We aimed to address this knowledge gap.

METHODS

T-wave amplitudes were automatically measured in 12-lead ECGs of patients presenting with acute chest discomfort to the emergency department within a prospective diagnostic multicenter study. The final diagnosis was centrally adjudicated by 2 independent cardiologists. Patients with left ventricular hypertrophy, complete left bundle branch block, or paced ventricular depolarization were excluded. The performance for lead-specific 95th- percentile thresholds were reported as likelihood ratios (lr), specificity, and sensitivity.

RESULTS

Myocardial infarction was the final diagnosis in 445 (18%) of 2457 patients. In most leads, T-wave amplitudes tended to be greater in patients without myocardial infarction than those with myocardial infarction, and T-wave amplitude exceeding the 95th percentile had positive and negative lr close to 1 or with confidence intervals (CIs) crossing 1. The exceptions were leads III, aVR, and V1, which had positive lrs of 3.8 (95% CI, 2.7 to 5.3), 4.3 (95% CI, 3.1 to 6.0) and 2.0 (95% CI, 1.4 to 2.9), respectively. These leads normally have inverted T waves, so T-wave amplitude exceeding the 95th percentile reflects upright rather than increased-amplitude hyperacute T waves.

CONCLUSION

Hyperacute T waves, when defined as increased T-wave amplitude exceeding the 95th percentile, did not provide useful information in diagnosing myocardial infarction in this sample.

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