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Abstract
Despite the great advances in cardiac diagnostic tools in the modern era of cardiology, but Electrocardiogram (ECG) is still a simple and non-invasive bedside diagnostic tool with a well-established role in the diagnosis of unstable angina and Non-ST elevation MI (UA/NSTEMI) and that is because of its simplicity, widespread availability and low cost (Lee HS et al;1993).
the aim of this study was to investigate the significance of T-wave polarity that associates the ST-segment depression in Non ST-segment Elevation Acute Coronary Syndromes with positive troponin T to predict the severity of coronary angiographic findings.
A total number of 40 patients with acute coronary syndrome either unstable angina (26 patients) or Non ST-segment elevation myocardial infarction (NSTEMI) (14 patients) were included in this study.
Our patients were classified into two groups according to the electrocardiographic ischemic changes during the attack of chest pain, all have ST-segment depression maximum in precordial leads V4-V5. The first group called (T+), and consists of patients with ST-segment depression and positive or upright T-wave. The second group called (T-), consists of patients with ST-segment depression and negative ( inverted) T-wave .
We selected patients whose troponin results were positive for the study ( as a marker of high risk state). Laboratarory data later on were used to distinguish unstable angina from Non ST-segment elevation myocardial infarction (NSTEMI) based on serial enzymes (CPK and CPK-MB). All patients were undergone coronary angiography within one month of the onset of the acute coronary syndrome.
There was a significant negative linear correlation between the negative T-wave polarity in leads V4-V5 and the degree of impaired systolic function represented as reduced ejection fraction while there was a significant positive linear correlation between the negative T-wave polarity in leads V4-V5 and the degree of impaired diastolic function represented as E/A ratio, wall motion score and the severity of CAD.