Hyperacute T Wave in the Early Diagnosis of Acute Myocardial Infarction.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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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, Martin-Sanchez F Javier, Kawecki Damian, Bürgler Franz, Keller Dagmar I, Abächerli Roger, Reuthebuch Oliver, Eckstein Friedrich S, Twerenbold Raphael, Reichlin Tobias, Mueller Christian, APACE investigators
Аннотация
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.