Detection and quantification of acute myocardial ischemia by morphologic evaluation of QRS changes by an angle-based method
(2013) In Journal of Electrocardiology 46(3). p.204-214- Abstract
- Objective: In acute myocardial ischemia changes within the QRS complex can add valuable information to that from the repolarization phase. This study evaluates three angles obtained from the main slopes of the R-wave within the QRS complex to assess acute myocardial ischemia. Methods: The QRS angles, denoted by empty set(R) (R-wave angle), empty set(U) (up-stroke angle) and empty set(D) (down-stroke angle), were evaluated in 12-lead electrocardiogram (ECG) recordings of 79 patients before and during coronary occlusion by elective percutaneous coronary intervention (PCI). In a subset of 38 patients, ischemia was quantified by myocardial scintigraphy. Results: At baseline the QRS angles presented low variations. During occlusion, empty... (More)
- Objective: In acute myocardial ischemia changes within the QRS complex can add valuable information to that from the repolarization phase. This study evaluates three angles obtained from the main slopes of the R-wave within the QRS complex to assess acute myocardial ischemia. Methods: The QRS angles, denoted by empty set(R) (R-wave angle), empty set(U) (up-stroke angle) and empty set(D) (down-stroke angle), were evaluated in 12-lead electrocardiogram (ECG) recordings of 79 patients before and during coronary occlusion by elective percutaneous coronary intervention (PCI). In a subset of 38 patients, ischemia was quantified by myocardial scintigraphy. Results: At baseline the QRS angles presented low variations. During occlusion, empty set(U) and empty set(D) developed a fast and abrupt change, whereas empty set(R) showed a smaller and gradual change. There were significant correlations between both maximal and sum of positive change in empty set(R) and ischemia: r = 0.67; p < 0:001 and r = 0.78; p <0.001, for extent, and r = 0.60; p < 0.001 and r = 0.73; p <0.001, for severity, respectively. Prediction of extent and severity of ischemia increased by 50% by adding empty set(R) changes to ST-segment changes, for LCX occlusions, whereas increased by 12.1% and 24.6% for LAD and RCA occlusions, respectively. No significant correlation was seen between empty set(u) and empty set(D) angles and ischemia. Conclusions: Evaluation of QRS angles from the standard 12-lead ECG represents a sensitive marker for detection of acute myocardial ischemia, whereas, empty set(R) changes can be used for prediction of its extent and severity. (C) 2013 Elsevier Inc. All rights reserved. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/3821456
- author
- Romero, Daniel ; Ringborn, Michael LU ; Laguna, Pablo and Pueyo, Esther
- organization
- publishing date
- 2013
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- QRS angles, PCI, Acute myocardial ischemia, Depolarization
- in
- Journal of Electrocardiology
- volume
- 46
- issue
- 3
- pages
- 204 - 214
- publisher
- Elsevier
- external identifiers
-
- wos:000318457600004
- scopus:84876686718
- pmid:23538112
- ISSN
- 1532-8430
- DOI
- 10.1016/j.jelectrocard.2013.02.014
- language
- English
- LU publication?
- yes
- id
- 39e5d87d-50aa-453a-9e7a-821eb3cd7e03 (old id 3821456)
- date added to LUP
- 2016-04-01 11:16:04
- date last changed
- 2022-03-20 07:27:21
@article{39e5d87d-50aa-453a-9e7a-821eb3cd7e03,
abstract = {{Objective: In acute myocardial ischemia changes within the QRS complex can add valuable information to that from the repolarization phase. This study evaluates three angles obtained from the main slopes of the R-wave within the QRS complex to assess acute myocardial ischemia. Methods: The QRS angles, denoted by empty set(R) (R-wave angle), empty set(U) (up-stroke angle) and empty set(D) (down-stroke angle), were evaluated in 12-lead electrocardiogram (ECG) recordings of 79 patients before and during coronary occlusion by elective percutaneous coronary intervention (PCI). In a subset of 38 patients, ischemia was quantified by myocardial scintigraphy. Results: At baseline the QRS angles presented low variations. During occlusion, empty set(U) and empty set(D) developed a fast and abrupt change, whereas empty set(R) showed a smaller and gradual change. There were significant correlations between both maximal and sum of positive change in empty set(R) and ischemia: r = 0.67; p < 0:001 and r = 0.78; p <0.001, for extent, and r = 0.60; p < 0.001 and r = 0.73; p <0.001, for severity, respectively. Prediction of extent and severity of ischemia increased by 50% by adding empty set(R) changes to ST-segment changes, for LCX occlusions, whereas increased by 12.1% and 24.6% for LAD and RCA occlusions, respectively. No significant correlation was seen between empty set(u) and empty set(D) angles and ischemia. Conclusions: Evaluation of QRS angles from the standard 12-lead ECG represents a sensitive marker for detection of acute myocardial ischemia, whereas, empty set(R) changes can be used for prediction of its extent and severity. (C) 2013 Elsevier Inc. All rights reserved.}},
author = {{Romero, Daniel and Ringborn, Michael and Laguna, Pablo and Pueyo, Esther}},
issn = {{1532-8430}},
keywords = {{QRS angles; PCI; Acute myocardial ischemia; Depolarization}},
language = {{eng}},
number = {{3}},
pages = {{204--214}},
publisher = {{Elsevier}},
series = {{Journal of Electrocardiology}},
title = {{Detection and quantification of acute myocardial ischemia by morphologic evaluation of QRS changes by an angle-based method}},
url = {{http://dx.doi.org/10.1016/j.jelectrocard.2013.02.014}},
doi = {{10.1016/j.jelectrocard.2013.02.014}},
volume = {{46}},
year = {{2013}},
}