Negative T Wave in Ischemic Heart Disease: A Consensus Article

Antonio Bayes de Luna*, Wojciech Zareba, Miquel Fiol, Kjell Nikus, Yochai Birnbaum, Rafael Baranowski, Diego Goldwasser, Paul Kligfield, Ryszard Piotrowicz, Guenter Breithardt, Hein Wellens

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


For many years was considered that negative T wave in ischemic heart disease represents ischemia and for many authors located in subepicardial area.We performed a review based in the literature and in the experience of the authors commenting the real significance of the presence of negative T wave in patients with ischemic heart disease.The negative T wave may be of primary or secondary type. Negative T wave observed in ischemic heart disease are of primary origin, therefore not a consequence of abnormal repolarization pattern. The negative T wave of ischemic origin presents the following characteristics: (1) are symmetrical and of variable deepness; (2) present mirror patterns; (3) starts in the second part of repolarization; and (4) may be accompanied by positive or negative U wave. The negative T wave of ischemic origin may be seen in the following clinical settings: (1) postmyocardial infarction due to a window effect of necrotic zone and (2) as a consequence of reperfusion in case of aborted MI when the artery has opened spontaneously, or after fibrinolysis, PCI, or coronary spasm.Acute ongoing ischemia do not cause negative T wave. This pattern appears when the ongoing ischemia is vanishing or in the chronic phase. In all these cases the cause of negative T wave is not located in the subepicardial area. Furthermore, positive exercise testing is expressed by ST depression never by isolated negative T wave. There are many circumstances that may present negative T wave outside ischemic heart disease and that have been discussed in this paper.? 2014
Original languageEnglish
Pages (from-to)426-441
JournalAnnals of Noninvasive Electrocardiology
Issue number5
Publication statusPublished - Sept 2014


  • electrocardiography
  • ischemic heart disease
  • negative T wave

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