GLOBAL T-WAVE INVERSION - LONG-TERM FOLLOW-UP

Objectives. This study evaluated 11-year follow-up data from patients with global T wave inversion. Background. In an 8-year prospective investigation, global T wave inversion was characterized by a long QT interval, unexplained marked female preponderance and, despite dramatic electrocardiographic (ECG) changes, an in-hospital prognosis not statistically different from that of the entire hospital population in which the condition it occurred. Methods. To assess long-term prognosis, these and an additional 18 patients (total 118 patients; 92 women and 26 men) with global T wave inversion were followed up prospectively for up to 11 years (mean 33.9 +/- 37.3 months). The additional patients did not significantly affect the in-hospital death rate (7.6 %; previously reported death rate 8%) and the total series continued not to differ from the entire in-hospital population in which it occurred (7.02%; p = NS). Results. Long-term survival was shortened by digoxin, faster heart rates, atrial fibrillation and, especially, a malignant condition. Eighteen (78.3%) of 23 patients with a malignant condition died during the follow-up period (p less-than-or-equal-to 0.0005), with a mean survival time of only 12 months. Kaplan-Meier curves also revealed the poor prognosis for those patients taking digoxin; 21 (63.9%) of 36 patients died (p = 0.008). Eleven of the 12 patients with atrial fibrillation were taking digoxin; 58.3% of these died, demonstrating a worse prognosis than that of patients with sinus rhythm, 35% of whom died (p = 0.005). Conclusions. Global T wave inversion continues to have an unexplained (78% vs. 22%) female preponderance. Although the long-term prognosis depends on underlying or associated diseases, the striking diffuse ECG changes do not in themselves imply a poor prognosis.