Document Detail

Diffuse ST depression with ST elevation in aVR: Is this pattern specific for global ischemia due to left main coronary artery disease?
MedLine Citation:
PMID:  23312698     Owner:  NLM     Status:  Publisher    
BACKGROUND AND PURPOSE: We assess whether the electrocardiographic (ECG) pattern of ST depression in >7 body surface leads combined with ST elevation in aVR and V(1) is predictive of left main coronary artery (LMCA) stenosis or left main equivalent (LMEQ) disease. METHODS: We collected 133 patients showing this particular ECG pattern. Patients with left bundle branch block, ventricular rhythm or ventricular paced rhythm were excluded. RESULTS: Only 28% of the patients had non-ST elevation acute coronary syndrome (NSTE-ACS). ECGs were classified as chronic, dynamic or no prior in 28%, 48% and 24%, respectively. A total of 57 patients (44%) underwent coronary angiography (CA). No significant coronary artery disease was found in 26%. LMCA/LMEQ disease was found in only 23% of these patients. The positive predictive value of the ECG pattern was not improved after exclusion of patients with intraventricular conduction abnormalities and left ventricular hypertrophy or in patients with dynamic ECG changes. CONCLUSIONS: This ECG pattern is not always caused by LMCA/LMEQ disease; therefore, the term "suspect circumferential subendocardial ischemia" may be preferred. Other medical conditions may also be associated with a similar ECG pattern.
Robert J Knotts; James M Wilson; Edward Kim; Henry D Huang; Yochai Birnbaum
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-8
Journal Detail:
Title:  Journal of electrocardiology     Volume:  -     ISSN:  1532-8430     ISO Abbreviation:  J Electrocardiol     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-14     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 © 2012 Elsevier Inc. All rights reserved.
The Section of Cardiology, The Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
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