Document Detail


Thoracic location of the lead with maximal ST-segment deviation during posterior and right ventricular ischemia: comparison of 18-lead ECG with 192 estimated body surface leads.
MedLine Citation:
PMID:  11265718     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
By using our database of continuous 18-lead electrocardiographic (ECG) recordings (standard + V3-5R + V7-9) during coronary angioplasty, we selected 68 patients with left circumflex balloon occlusions (posterior ischemia model) or proximal right coronary artery balloon occlusions (right ventricular IRV] ischemia model). ST-segment amplitudes (J + 60 ms) at preangioplasty baseline were subtracted from maximal ST amplitudes during balloon inflation to create a positive or negative change score (deltaST) for each of the 18 leads. DeltaST elevation was used to describe a change in the ST level in the positive direction from baseline, whether or not actual ST elevation from the isoelectric line was present. DeltaST depression was used to describe a change in the ST level in the negative direction from baseline, whether or not actual ST depression from the isoelectric line was present. ST amplitudes from 8 of the 12 standard leads were then used to estimate ST amplitudes at 192 body surface sites spanning the entire anterior and posterior thorax using the transformation technique of Lux. Thoracic distributions of the DeltaST values were displayed on a torso figure, including locations of the 18 lead locations and points of maximal ST elevation and depression. The 192 estimated body surface unipolar leads were compared with 18-lead ECGs (bipolar and unipolar). During 53 left circumflex occlusions, the maximal deltaST elevation was always located in the 18-lead ECG, with the most frequent locations at leads III, II (41%), V7-8 (34%), and V5-6 (25%). The maximal deltaST depression was located outside the 18-lead ECG (89%), with the most frequent locations above standard lead V2 (67%) and V3 (14%). During 16 proximal right coronary artery occlusions, the maximal deltaST elevation was always located in the 18-lead ECG, with the most frequent locations at leads III (81%) and V2-3R (13%). The maximal deltaST depression was located outside the 18-lead ECG (93%), with the most frequent locations above standard lead V2 (50%), V3 (14%), and V4 (14%). We conclude that maximal deltaST elevation is always located in the 18-lead ECG and maximal deltaST depression is frequently located outside of 18-lead ECG during left circumflex and proximal right coronary artery occlusions. Future studies are required to determine the bipolar leads for the 192 estimated body surface potential mapping leads.
Authors:
S F Wung; R L Lux; B J Drew
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of electrocardiology     Volume:  33 Suppl     ISSN:  0022-0736     ISO Abbreviation:  J Electrocardiol     Publication Date:  2000  
Date Detail:
Created Date:  2001-03-26     Completed Date:  2001-04-26     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0153605     Medline TA:  J Electrocardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  167-74     Citation Subset:  IM    
Affiliation:
Department of Medical-Surgical Nursing, College of Nursing, University of Illinois at Chicago, 60612-7350, USA. shufen@uic.edu
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MeSH Terms
Descriptor/Qualifier:
Angina, Unstable / physiopathology,  therapy
Angioplasty, Balloon
Body Surface Potential Mapping*
Electrocardiography / instrumentation*
Humans
Least-Squares Analysis
Myocardial Ischemia / physiopathology*,  therapy
Prospective Studies
Signal Processing, Computer-Assisted
Thorax
Ventricular Function, Right / physiology
Grant Support
ID/Acronym/Agency:
R01NR03436/NR/NINR NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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