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European Heart Journal 1990 11(7):634-642;
Copyright © 1990 by the European Society of Cardiology.
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© 1990 The European Society of Cardiology

The significance of U wave polarity in patients with a prior anterior myocardial infarction

N. KANEMOTO, J. HOSOKAWA and C. IMAOKA

Tokai University School of Medicine, Department of Internal Medicine Isehara, Japan

Received 30 March 1989; revised 29 August 1989; .

Correspondence: N. Kanemoto, Tokai University School of Medicine, Department of Internal Medicine, Bohseidai, Isehara, 259–11, Japan

Abstract

The significance of the polarity of U waves in left precordial leads in patients with a prior anterior myocardial infarction was evaluated in relation to left ventricular function and wall motion by left ventriculography. Ninety-six such patients, with a mean age of 53 years, were divided into three groups according to the polarity ofU waves: positive U waves (group P), isoelectric or flat U waves (group F), and negative U waves (group N). The following parameters were analysed: (I) Selvester ECG score; (2) global ejection fraction (EF); (3) regional area change; (4) number of asynergic and akinetic segment al radii; (5) asynergic and akinetic areas. Fifteen patients served as controls.

The Selvester ECG scores increased progressively and EF decreased successively with statistically significant differences between groups P, F, and N (P<0.01, respectively). The sensitivity of negative U waves for predicting EF of less than 50% was 88.0%, the specificity 81.9%, and the accuracy 84.4%. The incidence of regional area change at the apex of less than 20% was 10.0% in group P, 35.9% in group F, and 74.3% in group N (P < 0.01). The number of dyssynergic and akinetic radii, and asynergic and akinetic areas increased progressively from group P to F, to N (P < 0.01).

These results demonstrate that the polarity of U waves correlated significantly with left ventricular function and wall motion as well as the size of myocardial infarction. Negative U waves are an important sign of extensive myocardial infarction involving the apex with global eject ion fraction of less than 50%. Negative U waves may be associated with lateral ischaemia.

Key Words: Polarity of U wave • negative U wave • anterior myocardial infarction • global ejection fraction • apical infarction


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