Document Detail


Value of ST-segment depression in lead V4R in predicting proximal against distal left circumflex artery occlusion in acute inferoposterior myocardial infarction.
MedLine Citation:
PMID:  17262766     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Lead V(4R) faces the right ventricular free wall; it also reflects ischemia in the posterolateral wall lying opposite and manifests as ST-segment depression. HYPOTHESIS: The aim of this study was to evaluate the usefulness of V(4R) ST-segment depression in distinguishing proximal from distal left circumflex artery occlusion in acute inferoposterior wall myocardial infarction. METHODS: We retrospectively analyzed 239 patients who had first acute inferoposterior myocardial infarction, were admitted within 6 h from onset of symptom, and had coronary angiography performed within 4 weeks. Patients who had bundle-branch block or concomitant significant stenoses in the proximal and distal segments of the same vessel or of both vessels were excluded. The electrocardiographic and angiographic findings were reviewed by two independent groups of investigators. RESULTS: V(4R) ST-segment depression > or =1.0 mm was found in 8 of 46 patients (17.4%) with left circumflex artery occlusion but none (0%) with right coronary artery occlusion. Among the group with left circumflex artery occlusion, the mean magnitude of V(4R) ST-segment depression was greater in proximal than distal occlusion (0.82 +/- 0.65 vs. 0.03 +/- 0.12 mm, p < 0.0001). V(4R)ST-segment depression > or =1.0 mm was found in 8 of 14 patients (57.1%) with proximal occlusion but none (0%) in 32 patients with distal occlusion. The sensitivity and specificity to predict proximal occlusion were 57.1 and 100%, respectively. CONCLUSIONS: V(4R) ST-segment depression > or =1.0 mm was not useful for differentiating left circumflex and right coronary artery occlusion because of its low sensitivity. It is a fairly sensitive and very specific sign of proximal left circumflex artery occlusion.
Authors:
Man-Hong Jim; Hee-Hwa Ho; Chung-Wah Siu; Raymond Miu; Carmen Wing-Sze Chan; Stephen Wai-Luen Lee; Chu-Pak Lau
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical cardiology     Volume:  30     ISSN:  0160-9289     ISO Abbreviation:  Clin Cardiol     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2007-02-05     Completed Date:  2007-04-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  36-41     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2007 Wiley Periodicals, Inc.
Affiliation:
Cardiac Medical Unit, Grantham Hospital Hong Kong, 125 Wong Chuk Hang Road, Hong Kong. jimmanh2002@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Angiography
Coronary Disease / diagnosis*,  etiology
Electrocardiography*
Female
Humans
Male
Middle Aged
Myocardial Infarction / physiopathology*
Predictive Value of Tests

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


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