Clinical Significance of Electrocardiographic T -Wave Normalization with Exercise

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Abstract
A change from inverted T waves at rest to an upright position with exercise, has been debated to be a sign of myocardial ischemia. Retrospective analysis has been performed on exercise thallium-201 myocardial scintigrams from 82 consecutive patients with T-wave inversion of at least 1 mm or more on their resting electrocardiogram (ECG) and normalization with exercise. Ischemia was indicated by a transient myocardial perfusion defect with exercise, and probable scar was indicated by a fixed myocardial defect. This gave four groups: (I) 30 patients had no defects; (II) 36 patients had fixed defects alone; (III) 2 patients had transient defects alone, and (IV) 15 patients had both fixed and transient myocardial perfusion defects. Sixty-six out of 83 (80%) studies with normalization demonstrated no transient myocardial perfusion defect. T-wave normalization occurred often in the leads corresponding to the area of fixed myocardial perfusion defect (77% in group II and 80% in group IV). In 33 patients with coronary angiography, correlation was similar with T-wave normalization found in the distribution of coronary artery disease in 77%. Compared to 251 consecutive patients undergoing exercise thallium testing for suspected coronary artery disease, the study group had a similar frequency of scans without defects, but relatively more studies with fixed relative to transient defects. We conclude that normalization is a nonspecific finding which may be associated with coronary artery disease and fixed myocardial perfusion defect. T-wave normalization with exercise has poor positive predictive value for the diagnosis of transient myocardial perfusion defect.

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