Research Article

Value of electrocardiographic T wave inversion in lead aVL in prediction of Mid Left Anterior Descending Stenosis in patients with stable Coronary Artery disease

Gehan Magdy* and Awad Yousef

Published: 18 August, 2017 | Volume 2 - Issue 1 | Pages: 056-062

Background: The electrocardiogram (ECG) is a simple and noninvasive bedside diagnostic tool with a well-established role in the diagnosis of coronary artery disease (CAD). We aimed to study the diagnostic value of electrocardiographic ST-T wave changes in lead aVL in prediction of site of coronary artery stenosis in patients with chronic stable angina.

Patients and Methods: study was conducted on 156 patients referred for invasive coronary angiography with history of stable CAD as proved by non- invasive tests, 12 lead ECG was recorded and fully interpreted with more focus on T wave direction in aVL lead. T waves in aVL were categorized into one of three groups: upright, flat or inverted.

Results: regarding T wave in lead aVL, inverted T wave was reported in 71(45.5%) patients, 58 (37.2%) patients were with upright T wave in lead aVL and 27(17.3%) patients were with flat T wave in lead aVL, and we found that inverted T wave in lead aVL was most evident in 56(73.7%) patients with mid LAD with (highest κ value equal to 0.550[moderate agreement], and p value<0.001.

Conclusions: This study confirmed the diagnostic value of T wave inversion in lead aVL in prediction of mid left anterior descending artery lesions in patients with stable coronary artery disease.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001015 Cite this Article Read Full Article PDF


T wave inversion; Left anterior descending artery; Stable coronary artery disease


  1. Gaziano JM, Manson J, Ridker PM. A Textbook of Cardiovascular Medicine 8th ed Philadelphia, PA: Saunders Elsevier. 2007.
  2. Mensah GA, Brown DW. An overview of cardiovascular disease burden in the United States. Health Aff (Millwood). 2007; 26: 38-48. Ref.: https://goo.gl/Ay6Fff
  3. Masood Ali Akbar, Imran Waheed, Salman Munir, Shahid Amin, Nadeem Hayat Mallick. Study of electrocardiographic t wave inversion in patients with tight mid left anterior descending artery stenosis. Cardiovasc Dis. 2014; 12: 30-32.
  4. Nyman I, Areskog M, Areskog NH, Swahn E, Wallentin L. The RISC Study Group. Very early risk stratification by electrocardiogram at rest in men with suspected unstable coronary heart disease. J Intern Med. 1993; 234: 293-301. Ref.: https://goo.gl/J34NZQ
  5. Okada M, Yotsukura M, Shimada T, Ishikawa K. Clinical implications of isolated T wave inversion in adults: electrocardiographic differentiation of the underlying causes of this phenomenon. J Am Coll Cardiol. 1994; 24: 739-745. Ref.: https://goo.gl/LbLea3
  6. De Zwaan C, Bär FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J. 1982; 103: 730-736. Ref.: https://goo.gl/FbfUVC
  7. Rhinehardt J, Brady WJ, Perron AD, Mattu A. Electrocardiographic manifestations of Wellens’ syndrome. Am J Emerg Med. 2002; 20: 638-643. Ref.: https://goo.gl/q7ZhNQ
  8. Chatterjee K, Harris A, Davies G, Leatham A. Electrocardiographic changes subsequent to artificial ventricular depolarization. Br Heart J. 1969; 31: 770-779. Ref.: https://goo.gl/yGNn9z
  9. Gorgels AP, Vos MA, Mulleneers R, De Zwaan C, Bär FW, et al. Value of the electrocardiogram in diagnosing the number of severely narrowed coronary arteries in rest angina pectoris. Am J Cardiol. 1993; 72: 999-1003. Ref.: https://goo.gl/Piw9km
  10. Engelen DJ, Gorgels AP, Cheriex EC, De Muinck ED, Ophuis AJ, Dassen WR, et al. Value of the electrocardiogram in local­izing the occlusion site in the left anterior descending coronary artery in acute anterior myocardial infarction. J Am CollCardiol. 1999; 34: 389-395. Ref.: https://goo.gl/n9EjpY
  11. Tamura A, Kataoka H, Mikuriya Y, Nasu M. Inferior ST seg­ment depression as a useful marker for identifying proximal left anterior descending artery occlusion during acute ante­rior myocardial infarction. Eur Heart J. 1995; 16: 1795-1799. Ref.: https://goo.gl/bjJB7J
  12. Hassen GW, Costea A, Smith T, Carrazco C, Hussein H, et al. The neglected lead on electrocardiogram: T wave inver­sion in lead aVL, nonspecific finding or a sign for left anterior descending artery lesion? J Emerg Med. 2014; 46: 165-170. Ref.: https://goo.gl/CEaEid
  13. Farhan HL, Hassan KS, Al-Belushi A, Sallam M, Al-Zakwani I. Diagnostic Value of Electrocardiographic T Wave Inversion in Lead aVL in Diagnosing Coronary Artery Disease in Patients with Chronic Stable Angina.Oman Med J.2010; 25: 124-127. Ref.: https://goo.gl/kvJmjf
  14. Jukema JW, Vliegen HW, Bruschke AVG. Coronary angiography: principles, technique and interpretation. 1e druk, Leiden, the Netherlands, 2009. Chapter 3: 23-34.
  15. Zimetbaum PJ, Josephson ME. Use of the electrocardiogram in acute myocardial infarction. New England Journal of Medicine. 2003; 348: 933-940.
  16. Goldberger AL. Clinical Electrocardiography: A Simplified Approach, 7th ed. St. Louis, Mosby/Elsevier 2006.
  17. Quyyumi AA, Crake T, Rubens MB, Levy RD, Rickards AF, Fox KM. Importance of “reciprocal” electrocardiographic changes during occlusion of left anterior descending coronary artery. Studies during percutaneous transluminal coronary angioplasty. Lancet. 1986; 1: 347-350. Ref.: https://goo.gl/o7coq6
  18. Tamura A, Kataoka H, Mikuriya Y, Nasu M. Inferior ST segment depression as a useful marker for identifying proximal left anterior descending artery occlusion during acute anterior myocardial infarction. Eur Heart. J 1995; 16: 1795-1799. Ref.: https://goo.gl/dLcQpT
  19. Hanna EB, Glancy DL. ST-segment depression and T-wave inversion: classification, differential diagnosis, and caveats. Cleve Clin J Med. 2011; 78: 404-414. Ref.: https://goo.gl/mJZabJ
  20. Rashduni DL, Tannenbaum AK. Utility of ST segment depression in lead AVL in the diagnosis of right ventricular infarction. N J Med. 2003; 100: 35-37. Ref.: https://goo.gl/UJRU7T
  21. Turhan H, Yilmaz MB, Yetkin E, Atak R, Biyikoglu SF, et al. Diagnostic value of aVL derivation for right ventricular involvement in patients with acute inferior myocardial infarction. Ann Noninvasive Electrocardiol. 2003; 8: 185-188. Ref.: https://goo.gl/h6A56h
  22. GetawWorku Hassen, Ana Costea, Claire Carrazco, Tsion Frew, Anand Swaminathan, et al. Isolated T Wave Inversion in Lead aVL: An ECG Survey and a Case Report. Emerg Med Int. 2015. Ref.: https://goo.gl/AYsoem
  23. Getaw Worku Hassen, Soheila TalebiGeorge Fernaine, Hossein Kalantari. Lead aVL on electrocardiogram: emerging as important lead in early diagnosis of myocardial infarction? Am J Emerg Med. 2014; 32: 785-788. Ref.: https://goo.gl/iavH1S


Figure 1

Figure 1

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More