Abstract：Abnormal T waves are commonly seen in ECGs of healthy people, however the clinical significance of discordant T wave in lead aVR and its relationship with cardiovascular diseases has not been found. In America and Finland, the risk of cardiovascular death among healthy people with discordant T waves in lead aVR is 5 times higher than those with concordant T waves. For the patients with coronary heart disease(CHD) and old myocardial infarction(OMI), the incidence of cardiac endpoint events significantly increases among those with discordant T waves in lead aVR. For the patients with anterior OMI complicated by discordant T waves in lead aVR,hemodynamic changes are worsened. For CHD patients with ischemic cardiomyopathy, discordant T waves in lead aVR is closely related to sudden cardiac arrest and the incidence of sudden cardiac arrest is significantly higher than those with concordant T waves. The electrophysiological phenomenon of discordant T waves in lead aVR plays an important role in predicting the poor prognosis of the patients with potential cardiomyopathy and those with chronic kidney disease undergoing renal dialysis. It is also clinically valuable in making differential diagnosis between stress cardiomyopathy and acute myocardial infarction. The physiopathologic mechanism of discordant T waves in lead aVR is related to various factors including left cardiac insufficiency, increased ventricular wall stress, abnormal myocardial motion after myocardial infarction, and repolarization abnormality caused by denervation of myocardium after myocardial infarction.
2017, Vol. 26 
