Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Feb 26, 2015; 7(2): 86-100
Published online Feb 26, 2015. doi: 10.4330/wjc.v7.i2.86
Cardiac and non-cardiac causes of T-wave inversion in the precordial leads in adult subjects: A Dutch case series and review of the literature
Salah AM Said, Rene Bloo, Ramon de Nooijer, Andries Slootweg
Salah AM Said, Rene Bloo, Ramon de Nooijer, Andries Slootweg, Department of Cardiology, Hospital Group Twente, Almelo-Hengelo, 7555 DL Hengelo, The Netherlands
Author contributions: Said SAM, Bloo R, de Nooijer R and Slootweg A treated patients and collected material and clinical data from patients; Bloo R performed the assays; de Nooijer R analysed data; Said SAM wrote the paper; all authors approved the final version of the manuscript.
Ethics approval: The study is reviewed and approved by the Hospital Group Twente, Institutional Review Board. Verbal consent was taken from the patients and ethical clearance and permission to publish the cases is obtained from the Hospital Group Twente, Institutional Review Board.
Informed consent: All study participants provided verbal informed consent.
Conflict-of-interest: The authors declare no conflict of interest.
Data sharing: Technical appendix, statistical code, and dataset available from the corresponding author at salah.said@gmail.com. Informed consent, neither verbal nor written, was obtained for data sharing but the presented data are anonymized and risk of identification is negligible.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Salah AM Said, MD, PhD, FESC, Department of Cardiology, Hospital Group Twente, Almelo-Hengelo, Geerdinksweg 141, 7555 DL Hengelo, The Netherlands. salah.said@gmail.com
Telephone: +31-88-7085286 Fax: +31-88-7085289
Received: October 28, 2014
Peer-review started: October 28, 2014
First decision: November 27, 2014
Revised: December 14, 2014
Accepted: January 9, 2015
Article in press: January 12, 2015
Published online: February 26, 2015
Processing time: 106 Days and 10.8 Hours
Abstract

AIM: To describe the electrocardiographic (ECG) phenomena characterized by T-wave inversion in the precordial leads in adults and to highlight its differential diagnosis.

METHODS: A retrospective chart review of 8 adult patients who were admitted with ECG T-wave inversion in the anterior chest leads with or without prolongation of corrected QT (QTc) interval. They had different clinical conditions. Each patient underwent appropriate clinical assessment including investigation for myocardial involvement. Single and multimodality non-invasive, semi-invasive and invasive diagnostic approach were used to ascertain the diagnosis. The diagnostic assessment included biochemical investigation, cardiac and abdominal ultrasound, cerebral and chest computed tomography, nuclear medicine and coronary angiography.

RESULTS: Eight adult subjects (5 females) with a mean age of 66 years (range 51 to 82) are analyzed. The etiology of T-wave inversion in the precordial leads were diverse. On admission, all patients had normal blood pressure and the ECG showed sinus rhythm. Five patients showed marked prolongation of the QTc interval. The longest QTc interval (639 ms) was found in the patient with pheochromocytoma. Giant T-wave inversion (≥ 10 mm) was found in pheochromocytoma followed by electroconvulsive therapy and finally ischemic heart disease. The deepest T-wave was measured in lead V3 (5 ×). In 3 patients presented with mild T-wave inversion (patients 1, 5 and 4 mm), the QTc interval was not prolonged (432, 409 and 424 msec), respectively.

CONCLUSION: T-wave inversion associated with or without QTc prolongation requires meticulous history taking, physical examination and tailored diagnostic modalities to reach rapid and correct diagnosis to establish appropriate therapeutic intervention.

Keywords: T-wave inversion; Coronary angiography; Pulmonary computed tomography angiography; Magnetic resonance imaging; Differential diagnosis

Core tip: Myriad of clinical conditions have been described in association with T-wave inversion in the anterior precordial leads. T-wave inversion associated with or without corrected QT prolongation may be encountered in a variety of clinical conditions. In the reversible (dynamic) types such as vascular coronary, cerebral and pulmonary disorders; metabolic disturbances and acute adrenergic stress cardiomyopathy; resolution of T-wave inversion may occur after days, weeks, months or years following the index event. Tailored diagnostic approach should be conducted avoiding overuse of diagnostic methods. Specific tailored therapeutic interventions were undertaken when high index of clinical suspicion was raised towards certain disease entity.