Electrocardiographic ST-segment monitoring during controlled occlusion of coronary arteries

Andreas Haeberlin; Evelyn Studer; Thomas Niederhauser; Michael Stoller; Thanks Marisa; Josef Goette; Marcel Jacomet; Tobias Traupe; Christian Seiler; Rolf Vogel

doi:10.1016/j.jelectrocard.2013.10.003

Electrocardiographic ST-segment monitoring during controlled occlusion of coronary arteries

J Electrocardiol. 2014 Jan-Feb;47(1):29-37. doi: 10.1016/j.jelectrocard.2013.10.003. Epub 2013 Oct 17.

Authors

Affiliations

¹ Department of Cardiology, Bern University Hospital, Bern, Switzerland; ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland.
² ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland; Institute of Human Centered Engineering, Bern University of Applied Sciences, Bern, Switzerland.
³ Department of Cardiology, Bern University Hospital, Bern, Switzerland.
⁴ Institute of Human Centered Engineering, Bern University of Applied Sciences, Bern, Switzerland.
⁵ Department of Cardiology, Bürgerspital Solothurn, Solothurn, Switzerland. Electronic address: [email protected].

PMID: 24238737
DOI: 10.1016/j.jelectrocard.2013.10.003

Abstract

Background: Ischemia monitoring cannot always be performed by 12-lead ECG. Hence, the individual performance of the ECG leads is crucial. No experimental data on the ECG's specificity for transient ischemia exist.

Methods: In 45 patients a 19-lead ECG was registered during a 1-minute balloon occlusion of a coronary artery (left anterior descending artery [LAD], right coronary artery [RCA] or left circumflex artery [LCX]). ST-segment shifts and sensitivity/specificity of the leads were measured.

Results: During LAD occlusion, V3 showed maximal ST-segment elevation (0.26mV [IQR 0.16-0.33mV], p=0.001) and sensitivity/specificity (88% and 80%). During RCA occlusion, III showed maximal ST-elevation (0.2mV [IQR 0.09-0.26mV], p=0.004), aVF had the best sensitivity/specificity (85% and 68%). During LCX occlusion, V6 showed maximal ST-segment elevation (0.04mV [IQR 0.02-0.14mV], p=0.005), and sensitivity/specificity was (31%/92%) but could be improved (63%/72%) using an optimized cut-off for ischemia.

Conclusion: V3, aVF and V6 show the best performance to detect transient ischemia.

Keywords: Coronary occlusion; ECG; ST-segment monitoring.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Algorithms*
Coronary Occlusion / complications*
Coronary Occlusion / diagnosis*
Diagnosis, Computer-Assisted / methods*
Electrocardiography / methods*
Female
Humans
Male
Reproducibility of Results
Sensitivity and Specificity