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Vectorcardiogram synthesized from the 12-lead electrocardiogram to image ischemia.

Strauss, David G LU ; Olson, Charles W; Wu, Katherine C; Heiberg, Einar LU ; Persson, Eva LU ; Selvester, Ronald H; Pahlm, Olle LU and Arheden, Håkan LU (2009) In Journal of Electrocardiology 42(2). p.190-197
Abstract
BACKGROUND: Knowledge of the location and size of ischemic myocardium at risk for infarction could impact prehospital patient triage and reperfusion therapy. The 12-lead electrocardiogram (ECG) can roughly estimate ischemia size; however, individual precordial ECG leads are at different distances from the left ventricle (LV) and certain LV walls have greater effects on the ECG. Vectorcardiographic corrected orthogonal lead systems can display the magnitude and direction of the ST-segment "injury current" vector in 3-dimensional space. We assessed whether the vectorcardiographic ST-vector direction and magnitude derived from the ECG by the inverse-Dower method can estimate the location and size of ischemia. METHODS AND RESULTS: Thirty-two... (More)
BACKGROUND: Knowledge of the location and size of ischemic myocardium at risk for infarction could impact prehospital patient triage and reperfusion therapy. The 12-lead electrocardiogram (ECG) can roughly estimate ischemia size; however, individual precordial ECG leads are at different distances from the left ventricle (LV) and certain LV walls have greater effects on the ECG. Vectorcardiographic corrected orthogonal lead systems can display the magnitude and direction of the ST-segment "injury current" vector in 3-dimensional space. We assessed whether the vectorcardiographic ST-vector direction and magnitude derived from the ECG by the inverse-Dower method can estimate the location and size of ischemia. METHODS AND RESULTS: Thirty-two patients underwent elective coronary angioplasty with control and 5-minute balloon-occlusion ECG and sestamibi injection followed by single photon emission computed tomography (SPECT). The ST-vector direction derived from the inverse-Dower method was projected to an LV model with normal coronary artery anatomy. The graphical display of ST-vector location could discriminate among occlusions of the different coronaries. The ST-vector located ischemia within the SPECT defect in 75% (24/32) of all patients and 96% (24/25) of patients with ischemia in more than 12% of the LV. ST-vector magnitude had a Spearman correlation of r = 0.68 (P < .0001) with SPECT ischemia size. CONCLUSIONS: The 3-dimensional ST vector derived from the ECG can be graphically projected onto an LV model to localize ischemia, and ST-vector magnitude correlates with ischemia size. Further study is warranted to assess the ability of vectorcardiographic imaging to risk-stratify and provide decision-support for patients with acute myocardial infarction. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Electrocardiology
volume
42
issue
2
pages
190 - 197
publisher
Elsevier
external identifiers
  • wos:000264220000014
  • pmid:19237001
  • scopus:60349103500
ISSN
1532-8430
DOI
10.1016/j.jelectrocard.2008.12.018
language
English
LU publication?
yes
id
5442be4a-5800-4adb-912d-379fb1c2d775 (old id 1302280)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19237001?dopt=Abstract
date added to LUP
2009-03-03 12:39:44
date last changed
2017-08-27 05:45:57
@article{5442be4a-5800-4adb-912d-379fb1c2d775,
  abstract     = {BACKGROUND: Knowledge of the location and size of ischemic myocardium at risk for infarction could impact prehospital patient triage and reperfusion therapy. The 12-lead electrocardiogram (ECG) can roughly estimate ischemia size; however, individual precordial ECG leads are at different distances from the left ventricle (LV) and certain LV walls have greater effects on the ECG. Vectorcardiographic corrected orthogonal lead systems can display the magnitude and direction of the ST-segment "injury current" vector in 3-dimensional space. We assessed whether the vectorcardiographic ST-vector direction and magnitude derived from the ECG by the inverse-Dower method can estimate the location and size of ischemia. METHODS AND RESULTS: Thirty-two patients underwent elective coronary angioplasty with control and 5-minute balloon-occlusion ECG and sestamibi injection followed by single photon emission computed tomography (SPECT). The ST-vector direction derived from the inverse-Dower method was projected to an LV model with normal coronary artery anatomy. The graphical display of ST-vector location could discriminate among occlusions of the different coronaries. The ST-vector located ischemia within the SPECT defect in 75% (24/32) of all patients and 96% (24/25) of patients with ischemia in more than 12% of the LV. ST-vector magnitude had a Spearman correlation of r = 0.68 (P &lt; .0001) with SPECT ischemia size. CONCLUSIONS: The 3-dimensional ST vector derived from the ECG can be graphically projected onto an LV model to localize ischemia, and ST-vector magnitude correlates with ischemia size. Further study is warranted to assess the ability of vectorcardiographic imaging to risk-stratify and provide decision-support for patients with acute myocardial infarction.},
  author       = {Strauss, David G and Olson, Charles W and Wu, Katherine C and Heiberg, Einar and Persson, Eva and Selvester, Ronald H and Pahlm, Olle and Arheden, Håkan},
  issn         = {1532-8430},
  language     = {eng},
  number       = {2},
  pages        = {190--197},
  publisher    = {Elsevier},
  series       = {Journal of Electrocardiology},
  title        = {Vectorcardiogram synthesized from the 12-lead electrocardiogram to image ischemia.},
  url          = {http://dx.doi.org/10.1016/j.jelectrocard.2008.12.018},
  volume       = {42},
  year         = {2009},
}