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May positive U waves in V1-V3 leads predict left main coronary artery occlusion?/V1-V3 derivasyonlardaki pozitif U dalgalari sol ana koroner arter okluzyonunu ongorebilir mi?

A 41 years old male presented with unstable angina pectoris. Electrocardiography on admission revealed marked positive U waves in V1-V3 chest leads on electrocardiography (Fig. 1). Transthoracic echocardiography revealed a normal left ventricular ejection fraction. Early coronary angiography revealed critical occlusion of the distal left main coronary artery (LMCA) (Fig. 2). Coronary artery bypass surgery was offered to the patient. The characteristic electrocardiography patterns suggestive of the LMCA as culprit vessel are (1): ST depression in leads II, III or aVF (highest sensitivity 88%), ST elevation in both aVR and aVL (highest specificity 98%), ST elevation in aVR less than the ST elevation in V1 and right bundle branch block and left anterior fascicular block. Yamaji et al (2) showed that ST elevation in aVR greater than or equal to that in V1 distinguished LMCA group from left anterior descending coronary artery disease group with 81% sensitivity, 80% specificity and 81% accuracy. Other sensitive criteria of LMCA disease are ST deviation in V6-V1[greater than or equal to]0 and V6/V1[greater than or equal to]1 described by Mahajan et al (3) in the largest series of electrocardiography analysis on acute coronary syndrome resulting from culprit LMCA lesion. However, to the best of our knowledge, the relationship between positive U wave and LMCA occlusion has not been reported in the literature so far. Our patient is the first case showing this relationship in the literature.




(1.) Kurisu S, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Nakamura S, et al. Electrocardiographic features in patients with acute myocardial infarction associated with left main coronary artery occlusion. Heart 2004; 90: 1059-60.

(2.) Yamaji H, Iwasaki K, Kusachi S, Murakami T, Hirami R, Hamamoto H, et al. Prediction of acute left main coronary artery obstruction by 12 lead electrocardiography. ST elevation in lead aVR with less ST segment elevation in V1. J Am Coll Cardiol 2001; 38: 1348-54.

(3.) Mahajan N, Hollander G, Thekkoott D, Temple B, Malik B, Abrol S, et al. Prediction of left main coronary artery obstruction by 12-lead electrocardiography: ST segment deviation in lead V6 greater than or equal to ST segment deviation in lead V1. Ann Noninv Electrocardiol 2006; 11: 102-12.

Ersan Tatli, Tank Yildirim, Meryem Aktoz, Mutlu Buyuklu Department of Cardiology, Trakya University School of Medicine, Edirne, Turkey

Address for Correspondence/Yazisma Adresi: Dr. Ersan Tatli Trakya University School of Medicine, Cardiology, Edirne, Turkey Phone: +90 284 235 76 41/2100 Fax: +90 284 235 23 05 E-mail:
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Title Annotation:Letters to the Editor/Editore Mektuplar
Author:Tatli, Ersan; Yildirim, Tarik; Aktoz, Meryem; Buyuklu, Mutlu
Publication:The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi)
Article Type:Letter to the editor
Date:Aug 1, 2008
Previous Article:Bilateral common peroneal nerve palsy following cardiac surgery/Kardiyak cerrahi sonrasi bilateral komon peroneal sinir paralizi.
Next Article:A rare pathogen causing endocarditis: Streptococcus constellatus/Endokardite neden olan ender hir patojen: Streptococcus constellatus.

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