Prominent T wave in V-2 with respect to V-6 as a sign of lateral myocardial infarction

BACKGROUND: In the absence of confounding electrocardiographic features, a prominent R wave in leads V1-V2 reflects a lateral myocardial infarction (MI). We hypothesized that repolarization abnormalities in V1-V2 could also reflect a lateral MI. METHODS: We retrospectively selected a group of 57 patients with a recent or previous first Q-wave MI involving left ventricular (LV) inferior and/or lateral wall at contrast-enhanced cardiac magnetic resonance (CMR). The location and extent of the MI at CMR were compared with electrocardiographic features. RESULTS: The infarction was located in the inferior wall in 12 patients (21%), in the lateral wall in 8 (14%), and in both walls in 37 patients (65%). Infarct size corresponded to 16.8 (SD 9.0%) of LV myocardium. Infarct extent in the inferior and lateral wall (8.3%, SD 7.2% vs. 8.4%, SD 7.5% of LV myocardium) did not differ significantly. Using multiple linear regression analysis, inferior Q-waves and inferior negative T waves were directly associated with infarct extent in the inferior wall (p=0.014 and p=0.010, respectively). A prominent R wave in V1 and a prominent anterior T wave (expressed by the T wave amplitude in V2 minus its amplitude in V6) were directly associated with MI extent in the lateral wall (p=0.008 and p=0.018), while inferior negative T waves were negatively associated (p=0.006). CONCLUSIONS: In patients with MI of the inferior and/or lateral wall, a prominent T wave in V2 with respect to V6 reflects greater infarct extent in the lateral wall.