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Difference vectors to describe dynamics of the ST segment and the ventricular gradient in acute ischemia

ter Haar, C. Cato ; Maan, Arie C. ; Warren, Stafford G. ; Ringborn, Michael LU ; Horacek, B. Milan ; Schalij, Martin J. and Swenne, Cees A. (2013) In Journal of Electrocardiology 46(4). p.302-311
Abstract
Background: The ECG is important in the diagnosis and triage of the acute coronary syndrome (ACS), especially in the hyperacute phase, the "golden hours," during which myocardial salvage possibilities are largest. An important triaging decision to be taken is whether or not a patient requires primary PCI, for which, as mentioned in the guidelines, the presence of an ST elevation (STE) pattern in the ECG is a major criterion. However, preexisting non-zero ST amplitudes (diagnostic, but also non-diagnostic) can obscure or even preclude this diagnosis. Methods: In this study, we investigated the potential diagnostic possibilities of ischemia detection by means of changes in the ST vector, Delta ST, and changes in the VG (QRST integral)... (More)
Background: The ECG is important in the diagnosis and triage of the acute coronary syndrome (ACS), especially in the hyperacute phase, the "golden hours," during which myocardial salvage possibilities are largest. An important triaging decision to be taken is whether or not a patient requires primary PCI, for which, as mentioned in the guidelines, the presence of an ST elevation (STE) pattern in the ECG is a major criterion. However, preexisting non-zero ST amplitudes (diagnostic, but also non-diagnostic) can obscure or even preclude this diagnosis. Methods: In this study, we investigated the potential diagnostic possibilities of ischemia detection by means of changes in the ST vector, Delta ST, and changes in the VG (QRST integral) vector, Delta VG. We studied the vectorcardiograms (VCGs) synthesized of the ECGs of 84 patients who underwent elective PTCA. Mean +/- SD balloon occlusion times were 260 +/- 76 s. The ECG ischemia diagnosis (ST elevation, STE, or non-ST-elevation, NSTE), magnitudes and orientations of the ST and VG vectors, and the differences Delta ST and Delta VG with the baseline ECG were measured after 3 min of balloon occlusion. Results: Planar angles between the Delta ST and Delta VG vectors were 14.9 +/- 14.0 degrees. Linear regression of Delta VG on Delta ST yielded Delta VG = 324. Delta ST (r = 0.85; P < 0.0001, Delta ST in mV). We adopted Delta ST > 0.05 mV, and the corresponding Delta VG > 16.2 mV.ms as ischemia thresholds. The classical criteria characterized the ECGs of 46/84 (55%) patients after 3 min of occlusion as STE ECGs. Combined application of the Delta ST and Delta VG criteria identified 73/84 (87%) of the patients as ischemic. Conclusion: Differential diagnosis by Delta ST and Delta VG (requiring an earlier made non-ischemic baseline ECG) could dramatically improve ECG guided detection of patients who urgently require catheter intervention. (C) 2013 Elsevier Inc. All rights reserved. (Less)
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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Electrocardiogram, Vectorcardiogram, Acute coronary syndrome, Ischemia, Triage, PTCA, ST elevation, Non ST elevation, ST vector, Ventricular, gradient, Serial analysis
in
Journal of Electrocardiology
volume
46
issue
4
pages
302 - 311
publisher
Elsevier
external identifiers
  • wos:000321881300005
  • scopus:84879687225
  • pmid:23683543
ISSN
1532-8430
DOI
10.1016/j.jelectrocard.2013.04.004
language
English
LU publication?
yes
id
9644ab35-d5d0-4af2-805e-0caba1f2275e (old id 3974049)
date added to LUP
2016-04-01 10:48:11
date last changed
2022-01-26 02:38:11
@article{9644ab35-d5d0-4af2-805e-0caba1f2275e,
  abstract     = {{Background: The ECG is important in the diagnosis and triage of the acute coronary syndrome (ACS), especially in the hyperacute phase, the "golden hours," during which myocardial salvage possibilities are largest. An important triaging decision to be taken is whether or not a patient requires primary PCI, for which, as mentioned in the guidelines, the presence of an ST elevation (STE) pattern in the ECG is a major criterion. However, preexisting non-zero ST amplitudes (diagnostic, but also non-diagnostic) can obscure or even preclude this diagnosis. Methods: In this study, we investigated the potential diagnostic possibilities of ischemia detection by means of changes in the ST vector, Delta ST, and changes in the VG (QRST integral) vector, Delta VG. We studied the vectorcardiograms (VCGs) synthesized of the ECGs of 84 patients who underwent elective PTCA. Mean +/- SD balloon occlusion times were 260 +/- 76 s. The ECG ischemia diagnosis (ST elevation, STE, or non-ST-elevation, NSTE), magnitudes and orientations of the ST and VG vectors, and the differences Delta ST and Delta VG with the baseline ECG were measured after 3 min of balloon occlusion. Results: Planar angles between the Delta ST and Delta VG vectors were 14.9 +/- 14.0 degrees. Linear regression of Delta VG on Delta ST yielded Delta VG = 324. Delta ST (r = 0.85; P &lt; 0.0001, Delta ST in mV). We adopted Delta ST &gt; 0.05 mV, and the corresponding Delta VG &gt; 16.2 mV.ms as ischemia thresholds. The classical criteria characterized the ECGs of 46/84 (55%) patients after 3 min of occlusion as STE ECGs. Combined application of the Delta ST and Delta VG criteria identified 73/84 (87%) of the patients as ischemic. Conclusion: Differential diagnosis by Delta ST and Delta VG (requiring an earlier made non-ischemic baseline ECG) could dramatically improve ECG guided detection of patients who urgently require catheter intervention. (C) 2013 Elsevier Inc. All rights reserved.}},
  author       = {{ter Haar, C. Cato and Maan, Arie C. and Warren, Stafford G. and Ringborn, Michael and Horacek, B. Milan and Schalij, Martin J. and Swenne, Cees A.}},
  issn         = {{1532-8430}},
  keywords     = {{Electrocardiogram; Vectorcardiogram; Acute coronary syndrome; Ischemia; Triage; PTCA; ST elevation; Non ST elevation; ST vector; Ventricular; gradient; Serial analysis}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{302--311}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Electrocardiology}},
  title        = {{Difference vectors to describe dynamics of the ST segment and the ventricular gradient in acute ischemia}},
  url          = {{http://dx.doi.org/10.1016/j.jelectrocard.2013.04.004}},
  doi          = {{10.1016/j.jelectrocard.2013.04.004}},
  volume       = {{46}},
  year         = {{2013}},
}