Relationship Between a Positive T Wave in the Precordial V1 Lead and Advanced Coronary Artery Disease and 1-Year Mortality in Patients Undergoing Elective Coronary Angiography: An Observational Study

Document Type : Original Article


Cardiovascular Research Center, Tabriz University of Medical Science, Madani Heart Center, Cardiology Department, Tabriz, IR Iran.


Background: Data are scarce regarding the association between a positive T wave in the precordial lead V1 (TV1) and the severity of coronary artery disease (CAD) and long-term mortality in patients with suspected CAD and otherwise normal electrocardiograms (ECGs). The present study aimed to assess the association between a positive TV1 and the severity of coronary artery stenosis and 1-year mortality in patients with normal ECGs undergoing elective coronary angiography.
Methods: The present retrospective study enrolled 500 patients referred for elective coronary angiography and normal ECGs. We excluded patients with a history of myocardial infarction and acute coronary syndromes, bundle branch blocks, left ventricular hypertrophy, intraventricular conduction delays, significant valvular heart diseases, and permanent pacemakers. The patients were divided into 2 groups based on their ECG: patients with a positive TV1 and those with a negative or flat TV1.
Results: Out of 500 patients, 139 (27.8%) had a positive TV1. Multivessel CAD was more frequent in the patients with a positive TV1 than in those with a negative or flat TV1 (40.3% vs 28.5%; P=0.012). The 1-year mortality rate was significantly higher in the patients with a positive TV1 (9.4% vs 2.8%; P=0.003). A positive TV1 was an independent predictor of 1-year mortality (OR, 4.07; 95% CI, 2.16 to 7.62; P<0.001).
Conclusions: The findings of the present study suggest that a positive TV1 in patients with normal ECGs and suspected CAD is associated with advanced CAD and is an independent predictor of 1-year mortality. (Iranian Heart Journal 2023; 24(1): 6-14)


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