Determinants of persistent negative T waves and early versus late T wave normalisation after acute myocardial infarction

OBJECTIVE: To determine whether persistent versus early or delayed T wave normalisation of negative T waves after acute myocardial infarction is determined by the myocardial state, the treatment strategy, or both. DESIGN: 127 consecutive patients with a first acute myocardial infarction and > or = 2 negative T waves on the 24-36 hour ECG were studied. They underwent dobutamine stress echocardiography and coronary angiography during the first week. ECG was recorded at hospital discharge and at a mean (SD) of 4 (1) months. SETTING: University hospital. RESULTS: T wave normalisation was observed in 88 patients (early at discharge in 19 and delayed at four months in 69). Early T wave normalisation was associated with sustained contractile reserve during dobutamine stress (13 of 19 (68%)), whereas delayed T wave normalisation was observed mainly in patients with an ischaemic response (49 of 69 (71%)). The persistence of negative T waves was associated with an ischaemic response (21 of 39 (54%)) or persistent akinesis (17 of 39 (44%)). Among patients with an ischaemic response to dobutamine, in-hospital elective angioplasty was an independent determinant of delayed T wave normalisation (39 of 49 v 4 of 21 patients with persistent negative T waves at four months, p < 0.0001). CONCLUSIONS: Early T wave normalisation is associated with dobutamine induced, sustained improvement indicating myocardial stunning. Delayed normalisation is observed mainly in patients with ischaemic myocardium who have undergone revascularisation. Persistent negative T waves correspond to either extensive necrosis or non-revascularised, jeopardised myocardium.