Am J Med. 2021 Nov 20:S0002-9343(21)00741-5. doi: 10.1016/j.amjmed.2021.10.030. Online ahead of print.
BACKGROUND: The incidence of precordial T changes has been described in athletes and in specific populations, while the etiology in a large patient population admitted to the hospital has not previously been reported.
METHODS: All ECGs read by the same physician with new (compared to prior ECGs) or presumed new (no prior ECGs) precordial T wave inversions of >1 mm (0.1 mV) in multiple precordial leads were retrospectively reviewed and various ECG, patient-related and imaging parameters assessed. 226 patients and their ECGs were initially selected for analysis. Of these, 35 were eliminated leaving 191 for the final analysis.
RESULTS: Patients and their ECGs were divided into 5 groups based on diagnosis and incidence including Wellens' syndrome, takotsubo, type 2 myocardial infarction, other (including multiple diagnoses) and unknown. While subtle differences including number of T inversion leads, depth of T waves, QTc intervals and other variables were present between some groups, diagnosis in individual cases required appropriate clinical, laboratory and/or imaging studies. For example, although Wellens' syndrome was identified in <20% of cases, a presenting history of chest discomfort with precordial T changes either on the admission or next day ECG was highly sensitive and specific for this diagnosis. In some cases, Type 2 myocardial infarction can also have a Wellens' like ECG phenotype without significant left anterior descending disease.
CONCLUSIONS: Precordial T wave changes in hospitalized patients have various etiologies and, in individual cases, the changes on the ECG alone cannot easily distinguish the presumptive diagnosis and additional data are required.