Comparison between Negative T waves characteristics in acute coronary syndrome and pulmonary embolism

T Wave Inversion: A Screening Tool for Rapidly Differentiating Acute Coronary Syndrome and Pulmonary Embolism

Introduction Acute coronary syndrome (ACS) and acute pulmonary embolism (PE) are life-threatening conditions with similar clinical presentations. As current diagnostic tools, such as computed tomography pulmonary angiography, for distinguishing between these two conditions are time-consuming and may not be available in all settings, we tried in this study to devise a diagnostic tool based on electrocardiography to distinguish between ACS and acute PE based on T wave features. Methods Medical records of patients with diagnoses of ACS and acute PE, who were referred to three hospitals affiliated with Shiraz University of Medical Sciences, Shiraz, Iran, from March 2019 to March 2021, were evaluated. One expert cardiologist read patients' electrocardiograms (ECGs). All ECGs were recorded at the standard 25 mm/s and 10 mm/mV. The sum of T wave inversion or TWI (mV) in consecutive leads, including anterior leads (V1, V2, V3, and V4), inferior leads (II, III, aVF), and lateral leads (I, aVL, V5, and V6) were calculated to estimate the cut-off points used to differentiate ACS versus acute PE. The receiver operating characteristic (ROC) curve was used to estimate the diagnostic accuracy of T wave changes. The Youden index was used to calculate the optimum cut-offs for sensitivity and specificity. Results Of 151 patients with a mean age of 55.44±12.88 years, 74 were in the acute PE and 77 were in the ACS groups. The results showed that the TWI sum in anterior leads >1.2 mV (P<0.001), in lateral leads >0.9 mV (P<0.001), in anterior-to-inferior leads ratio >12 (P<0.001), and V4/V1 leads ratio >4 (P<0.001) rules out acute PE. Anterior-to-lateral TWI ratio (AUC=0.807, sensitivity=70.3%, specificity=10%) was significantly distinctive among ACS and acute PE patients. Conclusion TWI sum in anterior leads >1.2 mV, in lateral leads >0.9 mV, in anterior-to-inferior leads ratio >12, and in V4/V1 leads ratio >4 rules out acute PE. The anterior-to-lateral TWI ratio obtained from patients' ECG was significantly distinctive among the patients and can be used as a screening tool.

The S1S2S3 electrocardiographic pattern - Prevalence and relation to cardiovascular and pulmonary diseases in the general population

BACKGROUND

There is lack of studies exploring the incidence and association with diseases of the S1S2S3 electrocardiogram (ECG) pattern in the general population.

SUBJECTS AND METHODS

This population study included 6299 individuals aged 30+, and explored the prevalence and association between S1S2S3 and cardiovascular and pulmonary diseases. Criteria for the S1S2S3-I and S1S2S3-II ECG pattern were fulfilled when there was an S wave in the leads I, II and III, and the S-wave amplitude was greater than the R-wave amplitude in one or two of the leads, respectively.

RESULTS

The S1S2S3-I ECG pattern was found in 2332 subjects (36.9%). After age adjustment, hypertension was associated with S1S2S3-I (Odds ratio [OR] 1.25, 95% CI 1.12-1.41, p < 0.001). This age-adjusted association was statistically significant among men but not among women (OR 1.37, 1.16-1.62, p < 0.001 and OR 1.13, 0.97-1.33, p = 0.126, respectively). The S1S2S3-II ECG pattern was present in 193 subjects (3.1%). After age adjustment, heart failure proved to be associated with S1S2S3-II (OR 1.85, 1.18-2.90, p = 0.007). Dividing the population by sex, resulted in a statistically significant age-adjusted association for men but not for women (OR 2.30, 1.22-4.33, p = 0.010 and OR 1.59, 0.83-3.03, p = 0.159, respectively). Interactions with sex were statistically non-significant.

CONCLUSION

In the general adult population, the prevalence of the S1S2S3 ECG pattern is markedly affected by the diagnostic ECG criteria. The S1S2S3-I pattern was associated with hypertension, while S1S2S3-II was associated with heart failure, and both associations were enhanced in men. The associations with other studied cardiovascular and pulmonary diseases were minor and not clinically useful for risk stratification.