Identifying ischemic etiology of cardiomyopathy carries prognostic and therapeutic
significance. Clinical and electrocardiographic parameters can predict ischemic cardiomyopathy.
Positive T wave polarity in lead aVR (TPaVR) has been associated with adverse cardiac
events and severity of coronary artery disease. Medical records of adults evaluated
in an advanced heart failure referral clinic for cardiomyopathy with systolic dysfunction
(ejection fraction ≤ 40%) were retrospectively reviewed. Patients with ventricular
pacing were excluded. Significant predictors of ischemic cardiomyopathy from a univariate
logistic regression model were entered simultaneously into a multivariate logistic
regression model. A total of 180 patients met study inclusion criteria. Mean age of
the population was 52.5 ± 15.3 years old and 65% were men. Ischemic cardiomyopathy
was present in 52 patients (29%). Positive TPaVR was present in 57 patients (32%).
Ischemic cardiomyopathy was more common in patients with positive TPaVR (63% vs 13%,
p < 0.001). Ischemic cardiomyopathy was independently predicted by male gender, diabetes,
hyperlipidemia, absence of family history of cardiomyopathy, echocardiographic regional
wall motion abnormality, and positive TPaVR. The strongest association was with positive
TPaVR (odds ratio 30.5, 95% confidence interval 6.47 to 214; p < 0.001). T wave amplitude
of +0.025 mV in lead aVR was the optimal cutoff to distinguish ischemic and nonischemic
cardiomyopathy in receiver operating characteristic analysis (sensitivity 69.2%, specificity
83.6%, area under curve = 0.747, 95% confidence interval 0.658 to 0.836). In conclusion,
positive TPaVR was a strong predictor of ischemic etiology of cardiomyopathy.
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Article Info
Publication History
Published online: July 29, 2022
Received in revised form:
June 8,
2022
Received:
April 3,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: None.
Identification
Copyright
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