Myocardium in Man?

In this issue of Circulation, Renkin et all have made an intriguing observation in patients with unstable angina. They describe a subgroup of unstable angina patients with persistent inversion of precordial-lead T waves who have resting regional left ventricular wall motion abnormalities. Six months after left anterior descending angioplasty, these patients demonstrated normalization of T waves and improvement in regional wall motion. In contrast, another group of patients with unstable angina, who had a similar extent of coronary artery disease but upright T waves, did not demonstrate wall motion abnormalities and had no change in T waves or wall motion after angioplasty. The results suggest that persistently inverted T waves in the setting of unstable angina and in the absence of documented myocardial infarction may help identify patients who have viable but abnormally functioning myocardium. Identifying such myocardium is important because it may recover function after restoration of blood flow.