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Difference vectors to describe dynamics of the ST segment and the ventricular gradient in acute ischemia.
MedLine Citation:
PMID:  23683543     Owner:  NLM     Status:  Publisher    
BACKGROUND: The ECG is important in the diagnosis and triage of the acute coronary syndrome (ACS), especially in the hyperacute phase, the "golden hours," during which myocardial salvage possibilities are largest. An important triaging decision to be taken is whether or not a patient requires primary PCI, for which, as mentioned in the guidelines, the presence of an ST elevation (STE) pattern in the ECG is a major criterion. However, preexisting non-zero ST amplitudes (diagnostic, but also non-diagnostic) can obscure or even preclude this diagnosis. METHODS: In this study, we investigated the potential diagnostic possibilities of ischemia detection by means of changes in the ST vector, ΔST, and changes in the VG (QRST integral) vector, ΔVG. We studied the vectorcardiograms (VCGs) synthesized of the ECGs of 84 patients who underwent elective PTCA. Mean±SD balloon occlusion times were 260±76s. The ECG ischemia diagnosis (ST elevation, STE, or non-ST-elevation, NSTE), magnitudes and orientations of the ST and VG vectors, and the differences ΔST and ΔVG with the baseline ECG were measured after 3min of balloon occlusion. RESULTS: Planar angles between the ΔST and ΔVG vectors were 14.9±14.0°. Linear regression of ΔVG on ΔST yielded ΔVG=324·ΔST (r=0.85; P<0.0001, ΔST in mV). We adopted ΔST>0.05mV, and the corresponding ΔVG>16.2mV·ms as ischemia thresholds. The classical criteria characterized the ECGs of 46/84 (55%) patients after 3min of occlusion as STE ECGs. Combined application of the ΔST and ΔVG criteria identified 73/84 (87%) of the patients as ischemic. CONCLUSION: Differential diagnosis by ΔST and ΔVG (requiring an earlier made non-ischemic baseline ECG) could dramatically improve ECG guided detection of patients who urgently require catheter intervention.
C Cato Ter Haar; Arie C Maan; Stafford G Warren; Michael Ringborn; B Milan Horáček; Martin J Schalij; Cees A Swenne
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-5-14
Journal Detail:
Title:  Journal of electrocardiology     Volume:  -     ISSN:  1532-8430     ISO Abbreviation:  J Electrocardiol     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-5-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0153605     Medline TA:  J Electrocardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
Cardiology Department, Leiden University Medical Center, Leiden, the Netherlands.
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