T-wave inversion in the aVL lead is associated with severity of stenosis in the LAD artery

The clinical value of T wave inversion (TWI) in the lead aVL in diagnosing coronary artery disease (CAD) remains unclear. Hence, we aim to evaluate the association between TWI in the aVL lead and the severity and location of coronary artery stenosis in elective coronary angiography.

Electrocardiograms (ECGs) of 167 consecutive patients undergoing elective coronary angiography were analyzed. All patients had chronic stable angina. Patients with secondary T wave inversion had been excluded (67 patients). Detailed ECG and coronary angiographic findings were interpreted by experienced cardiologists. A total of 50 patients with isolated T wave inversion in the aVL lead (without other ECG abnormalities) and 50 control subjects with normal electrocardiogram were studied.

Of the 100 enrolled subjects, 54 were males and 47 were females and the mean age in this study was 63.77±9.2 years old (range 44-81). There was a significant relationship between the severity of stenosis in the LAD artery and TWI in the aVL lead (P<0.0001). The sensitivity and specificity of TWI in the aVL lead for LAD artery stenosis were 74% and 65%, respectively.

According to our study, TWI in the aVL lead exhibits a meaningful correlation with LAD artery stenosis, which is mostly associated with the stenosis of the middle portion of the artery, with relatively high sensitivity and specificity.