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. 1996 Nov;76(5):397–405. doi: 10.1136/hrt.76.5.397

How epicardial U-wave changes are reflected in body surface precordial electrocardiograms in anterior or inferoposterior myocardial ischaemia during coronary angioplasty.

H Kataoka 1, S Yano 1, A Tamura 1, Y Mikuriya 1
PMCID: PMC484569  PMID: 8944584

Abstract

OBJECTIVES: To examine the epicardial U-wave changes recorded in intracoronary electrocardiograms (ECGs) during anterior or inferoposterior myocardial ischaemia and the corresponding changes in precordial ECGs recorded from the body surface in humans. METHODS: 40 patients undergoing coronary angioplasty of the left anterior descending (LAD) coronary artery (22 patients) or left circumflex (LC) artery (18 patients). Intracoronary and surface precordial ECGs were simultaneously recorded under baseline conditions and during angioplasty. RESULTS: Four different patterns of U-wave change were identified on the intracoronary ECG: change to positivity, no change, change to negativity, and biphasic change. The incidence of each pattern was similar in the two groups (LAD v LC groups, 23% v 39%; 23% v 17%; 41% v 44%; 13% v 0%, respectively). The intracoronary ECG was more sensitive than the surface ECG for detecting U-wave changes (intracoronary v surface ECG: LAD group, 77% v 55%; LC group, 83% v 28%). A study of the correlation between intracoronary and surface precordial ECGs showed that in patients who had U-wave changes in their intracoronary ECG (17 LAD and 15 LC patients) 65% of the LAD group but only 6% of the LC group had primary U-wave changes in the surface precordial ECG, and that 27% of the LC patients had reciprocal U-wave changes in the right to central precordial ECG. CONCLUSIONS: These results provide fundamental information for an understanding of the correlation between U-wave changes in the epicardial and surface pre-cordial ECGs during myocardial ischaemia in humans. As well as the primary U-wave changes seen in many of those with anterior myocardial ischaemia, some of those with posterior myocardial ischaemia had reciprocal U-wave changes in their surface precordial ECGs.

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Selected References

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  1. BELLET S., KEMP R. L., SURAWICZ B. Polarity and amplitude of the U wave of the electrocardiogram in relation to that of the T wave. Circulation. 1957 Jan;15(1):90–97. doi: 10.1161/01.cir.15.1.90. [DOI] [PubMed] [Google Scholar]
  2. Berry C., Zalewski A., Kovach R., Savage M., Goldberg S. Surface electrocardiogram in the detection of transmural myocardial ischemia during coronary artery occlusion. Am J Cardiol. 1989 Jan 1;63(1):21–26. doi: 10.1016/0002-9149(89)91069-2. [DOI] [PubMed] [Google Scholar]
  3. Boden W. E., Spodick D. H. Diagnostic significance of precordial ST-segment depression. Am J Cardiol. 1989 Feb 1;63(5):358–361. doi: 10.1016/0002-9149(89)90346-9. [DOI] [PubMed] [Google Scholar]
  4. Bough E. W., Korr K. S. Prevalence and severity of circumflex coronary artery disease in electrocardiographic posterior myocardial infarction. J Am Coll Cardiol. 1986 May;7(5):990–996. doi: 10.1016/s0735-1097(86)80216-9. [DOI] [PubMed] [Google Scholar]
  5. Chikamori T., Yamada M., Takata J., Furuno T., Yamasaki F., Doi Y. L. Exercise-induced prominent U waves as a marker of significant narrowing of the left circumflex or right coronary artery. Am J Cardiol. 1994 Sep 1;74(5):495–499. doi: 10.1016/0002-9149(94)90912-1. [DOI] [PubMed] [Google Scholar]
  6. Eisenstein I., Sanmarco M. E., Madrid W. L., Selvester R. H. Electrocardiographic and vectorcardiographic diagnosis of posterior wall myocardial infarction. Significance of the T wave. Chest. 1985 Sep;88(3):409–416. doi: 10.1378/chest.88.3.409. [DOI] [PubMed] [Google Scholar]
  7. Friedman P. L., Shook T. L., Kirshenbaum J. M., Selwyn A. P., Ganz P. Value of the intracoronary electrocardiogram to monitor myocardial ischemia during percutaneous transluminal coronary angioplasty. Circulation. 1986 Aug;74(2):330–339. doi: 10.1161/01.cir.74.2.330. [DOI] [PubMed] [Google Scholar]
  8. Fu L. T., Kato N., Takahashi N. Ischaemia-induced negative U waves in electrocardiograms (an experimental study in canine hearts). Cardiovasc Res. 1982 May;16(5):240–248. doi: 10.1093/cvr/16.5.240. [DOI] [PubMed] [Google Scholar]
  9. Gerson M. C., McHenry P. L. Resting U wave inversion as a marker of stenosis of the left anterior descending coronary artery. Am J Med. 1980 Oct;69(4):545–550. doi: 10.1016/0002-9343(80)90465-9. [DOI] [PubMed] [Google Scholar]
  10. Gerson M. C., Phillips J. F., Morris S. N., McHenry P. L. Exercise-induced U-wave inversion as a marker of stenosis of the left anterior descending coronary artery. Circulation. 1979 Nov;60(5):1014–1020. doi: 10.1161/01.cir.60.5.1014. [DOI] [PubMed] [Google Scholar]
  11. Jain A., Jenkins M. G., Gettes L. S. Lack of specificity of new negative U waves for anterior myocardial ischemia as evidenced by intracoronary electrogram during balloon angioplasty. J Am Coll Cardiol. 1990 Apr;15(5):1007–1011. doi: 10.1016/0735-1097(90)90233-f. [DOI] [PubMed] [Google Scholar]
  12. Kataoka H. Relation of T-wave polarity in precordial V1 lead to right or left circumflex coronary pathoanatomy in acute inferior myocardial infarction. Chest. 1994 Feb;105(2):360–363. doi: 10.1378/chest.105.2.360. [DOI] [PubMed] [Google Scholar]
  13. Kataoka H., Tamura A., Mikuriya Y. Central precordial reciprocal ST-segment elevation in posterolateral myocardial infarction. Am Heart J. 1993 Apr;125(4):1202–1204. doi: 10.1016/0002-8703(93)90149-4. [DOI] [PubMed] [Google Scholar]
  14. Kishida H., Cole J. S., Surawicz B. Negative U wave: a highly specific but poorly understood sign of heart disease. Am J Cardiol. 1982 Jun;49(8):2030–2036. doi: 10.1016/0002-9149(82)90225-9. [DOI] [PubMed] [Google Scholar]
  15. Lepeschkin E. The U wave of the electrocardiogram. Mod Concepts Cardiovasc Dis. 1969 Aug;38(8):39–45. [PubMed] [Google Scholar]
  16. Matsuguchi T., Koiwaya Y., Nakagaki O., Takeshita A., Nakamura M. Transient U wave inversion during variant angina. Am Heart J. 1984 Oct;108(4 Pt 1):899–904. doi: 10.1016/0002-8703(84)90452-6. [DOI] [PubMed] [Google Scholar]
  17. Miwa K., Murakami T., Kambara H., Kawai C. U wave inversion during attacks of variant angina. Br Heart J. 1983 Oct;50(4):378–382. doi: 10.1136/hrt.50.4.378. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. PALMER J. H. Isolated U wave negativity. Circulation. 1953 Feb;7(2):205–210. doi: 10.1161/01.cir.7.2.205. [DOI] [PubMed] [Google Scholar]
  19. Rezkalla S., Moushmoush B., Connors B. C., Turi Z. G. Monitoring of ischemia during percutaneous coronary angioplasty: influence of guidewire, balloon placement, and lead selection. Cathet Cardiovasc Diagn. 1988;15(4):233–236. doi: 10.1002/ccd.1810150405. [DOI] [PubMed] [Google Scholar]
  20. Sclarovsky S., Topaz O., Rechavia E., Strasberg B., Agmon J. Ischemic ST segment depression in leads V2-V3 as the presenting electrocardiographic feature of posterolateral wall myocardial infarction. Am Heart J. 1987 May;113(5):1085–1090. doi: 10.1016/0002-8703(87)90916-1. [DOI] [PubMed] [Google Scholar]
  21. Spach M. S., Barr R. C., Lanning C. F., Tucek P. C. Origin of body surface QRS and T wave potentials from epicardial potential distributions in the intact chimpanzee. Circulation. 1977 Feb;55(2):268–268. doi: 10.1161/01.cir.55.2.268. [DOI] [PubMed] [Google Scholar]
  22. Taggart P., Sutton P., John R., Hayward R., Swanton H. The epicardial electrogram: a quantitative assessment during balloon angioplasty incorporating monophasic action potential recordings. Br Heart J. 1989 Nov;62(5):342–352. doi: 10.1136/hrt.62.5.342. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Yamakado T., Nakano T., Masuda T., Takezawa H. D. Coronary angiographic findings associated with U-wave inversion during coronary artery spasm. Am J Cardiol. 1987 Jul 1;60(1):188–190. doi: 10.1016/0002-9149(87)91011-3. [DOI] [PubMed] [Google Scholar]
  24. Yano H., Hiasa Y., Aihara T., Nakaya Y., Mori H. Inverted U wave in ergonovine-induced vasospastic angina. Clin Cardiol. 1987 Nov;10(11):633–639. doi: 10.1002/clc.4960101108. [DOI] [PubMed] [Google Scholar]
  25. Yano H., Hiasa Y., Aihara T., Nakaya Y., Mori H. Negative U wave during percutaneous transluminal coronary angioplasty. Clin Cardiol. 1991 Mar;14(3):232–236. doi: 10.1002/clc.4960140311. [DOI] [PubMed] [Google Scholar]

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