Koechlin, LucaLucaKoechlinStrebel, IvoIvoStrebelZimmermann, TobiasTobiasZimmermannNestelberger, ThomasThomasNestelbergerWalter, JoanJoanWalterLopez-Ayala, PedroPedroLopez-AyalaBoeddinghaus, JasperJasperBoeddinghausShrestha, SamyutSamyutShresthaArslani, KetinaKetinaArslaniStefanelli, SabrinaSabrinaStefanelliReuthebuch, BenediktBenediktReuthebuchWussler, DesireeDesireeWusslerRatmann, Paul DavidPaul DavidRatmannChrist, MichaelMichaelChristBadertscher, PatrickPatrickBadertscherWildi, KarinKarinWildiGiménez, Maria RubiniMaria RubiniGiménezGualandro, Danielle MDanielle MGualandroMiró, ÒscarÒscarMiróFuenzalida, CarolinaCarolinaFuenzalidaMartin-Sanchez, F JavierF JavierMartin-SanchezKawecki, DamianDamianKaweckiBürgler, FranzFranzBürglerKeller, Dagmar IDagmar IKellerAbächerli, RogerRogerAbächerliReuthebuch, OliverOliverReuthebuchEckstein, Friedrich SFriedrich SEcksteinTwerenbold, RaphaelRaphaelTwerenboldReichlin, Tobias RomanTobias RomanReichlin0000-0002-7197-8415Mueller, ChristianChristianMueller2024-10-152024-10-152023-08https://boris-portal.unibe.ch/handle/20.500.12422/121540STUDY OBJECTIVE The diagnostic performance of T-wave amplitudes for the detection of myocardial infarction is largely unknown. We aimed to address this knowledge gap. METHODS T-wave amplitudes were automatically measured in 12-lead ECGs of patients presenting with acute chest discomfort to the emergency department within a prospective diagnostic multicenter study. The final diagnosis was centrally adjudicated by 2 independent cardiologists. Patients with left ventricular hypertrophy, complete left bundle branch block, or paced ventricular depolarization were excluded. The performance for lead-specific 95th- percentile thresholds were reported as likelihood ratios (lr), specificity, and sensitivity. RESULTS Myocardial infarction was the final diagnosis in 445 (18%) of 2457 patients. In most leads, T-wave amplitudes tended to be greater in patients without myocardial infarction than those with myocardial infarction, and T-wave amplitude exceeding the 95th percentile had positive and negative lr close to 1 or with confidence intervals (CIs) crossing 1. The exceptions were leads III, aVR, and V1, which had positive lrs of 3.8 (95% CI, 2.7 to 5.3), 4.3 (95% CI, 3.1 to 6.0) and 2.0 (95% CI, 1.4 to 2.9), respectively. These leads normally have inverted T waves, so T-wave amplitude exceeding the 95th percentile reflects upright rather than increased-amplitude hyperacute T waves. CONCLUSION Hyperacute T waves, when defined as increased T-wave amplitude exceeding the 95th percentile, did not provide useful information in diagnosing myocardial infarction in this sample.en600 - Technology::610 - Medicine & healtharticle10.48350/1787013677420510.1016/j.annemergmed.2022.12.003