Appearance of Electrocardiographic Initial U‐Wave Inversion Dependent on Pressure‐Induced Early Diastolic Impairment in Patients with Hypertension

Background ECG U‐wave inversion can be classified as initial and terminal U inversion according to the phasic relationship to positive U‐wave deflection. Initial U inversion is occasionally observed in hypertensive patients while terminal U inversion frequently appears during severe myocardial ischemia. Hypothesis The genesis of initial U inversion may be related to pressure‐induced diastolic dysfunction. Methods In order to clarify the genesis of initial U‐wave inversion we studied 11 consecutive hypertensive patients with both initial U inversion and impaired left ventricular early relaxation who were evaluated using Doppler echocardiography. Results The U inversion disappeared during acute pressure lowering by sublingual administration of nitroglycerin. The U inversion also disappeared and relaxation improved significantly after chronic blood pressure lowering. Initial U inversion reappeared during a cold pressor test. Conclusion The appearance of initial U inversion was dependent on the pressure‐induced impaired left ventricular early relaxation in hypertensive patients. Copyright © 2009 Wiley Periodicals, Inc.