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Use of the electrocardiogram as an aid in screening for left ventricular aneurysm
Insights
Electrocardiograms (ECGs) can help screen for ventricular aneurysms in coronary artery disease patients. ST segment elevation on an ECG suggests a potential aneurysm, guiding the need for further left ventriculography.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) and cardiomyopathy can lead to ventricular aneurysms.
- Left ventriculography is used to identify surgically resectable ventricular aneurysms.
- The diagnostic utility of electrocardiograms (ECGs) as an initial screening tool for ventricular aneurysms requires evaluation.
Purpose of the Study:
- To assess the value of the electrocardiogram (ECG) as an initial screening technique for identifying ventricular aneurysms in patients with coronary artery disease or cardiomyopathy.
- To determine the correlation between specific ECG findings and the presence of left ventricular aneurysms.
Main Methods:
- Analysis of electrocardiograms (ECGs) and ventriculograms from 96 patients.
- Comparison of ECG findings (ST segment elevation, Q waves) with ventricular contractile motion and presence of aneurysms.
Main Results:
- Patients with normal ventricular motion and CAD rarely showed significant ST elevation or Q waves.
- All patients with left ventricular aneurysms exhibited at least 1 mm ST segment elevation, with 73% showing ≥2 mm and 80% having associated Q waves.
- Patients with localized hypocontractility showed ST elevation with Q waves less frequently (approx. 50%) than those with aneurysms.
Conclusions:
- Patients with suspected coronary disease lacking ST segment elevation are unlikely to have ventricular aneurysms, potentially sparing them from unnecessary left ventriculography.
- ST segment elevation on ECG is a useful screening sign for potential ventricular aneurysms.
- While ST elevation suggests a possible surgically remediable lesion, further left ventriculography is recommended when indicated to delineate the contractile disorder and assess viable muscle.
Abstract:
Attempting to cull from a population of patients with coronary artery disease or cardiomyopathy, a subgroup in whom left ventriculography might most reasonably be performed in search of a surgically resectable ventricular aneurysm, the electrocardiograms (ECGs) and ventriculograms of 96 patients were analyzed. This study was conceived to test the value of the ECG as an initial screening technique. Patients with normal ventricular contractile motion in the presence of coronary artery disease rarely showed ST segment elevation exceeding 2 mm in any lead, and even more rarely showed Q waves in corresponding leads. All patients with well defined left ventricular aneurysms had at least 1 mm ST segment elevation, and the majority (73%) had ST elevation of 2 mm or greater; in 80% of these, there were associated Q waves in the same lead. In patients with only local areas of hypocontractility, the frequency of ST segment elevation with concomitant Q waves was significantly less (approximately 50%) than that seen in patients with aneurysms. It is concluded that patients with suspected or proven coronary disease who fail to demonstrate ST segment elevation are unlikely to have ventricular aneurysms and, thus, would receive little diagnostic benefit from left ventriculography. The presence of ST segment elevation, with or without associated Q waves in the same leads, is a helpful screening sign, raising the possibility of a surgically remediable lesion such as a ventricular aneurysm, but similar electrocardiographic patterns are also seen in patients with non-operable localized or generalized disorders of contraction. Having discovered ST elevation, then, left ventriculography becomes a reasonable next step - when otherwise indicated - in delineating the type of contractile disorder as well as the amount of adequately functioning muscle.