Relationship between electrocardiographic patterns and angiographic features in isolated left circumflex coronary artery disease
W F Shen1, C Tribouilloy, J P Lesbre
1Department of Cardiology, South Hospital, University of Picardie, Amiens, France.
Insights
An abnormal R wave in lead V1 on an electrocardiogram (ECG) can predict proximal left circumflex (LCx) artery stenosis. This ECG pattern also identifies patients with LCx disease and heart attack who have left ventricular dysfunction.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) diagnosis relies on various methods.
- Electrocardiography (ECG) provides crucial insights into cardiac electrical activity.
- Left circumflex coronary artery (LCx) disease can present with diverse clinical and ECG findings.
Purpose of the Study:
- To investigate the correlation between specific electrocardiographic (ECG) patterns and clinical/angiographic features in patients with isolated left circumflex coronary artery (LCx) disease.
- To determine if ECG findings can predict the location of LCx stenosis and identify patients at higher risk for adverse cardiac events.
Main Methods:
- Retrospective analysis of 89 patients with isolated LCx disease.
- Correlation of ECG abnormalities (Q waves, R wave in V1, ST-T changes) with angiographic findings (stenosis location) and clinical outcomes (myocardial infarction, cardiac events).
Main Results:
- 75% of patients exhibited ECG abnormalities.
- An abnormal R wave in lead V1 was significantly associated with proximal LCx stenosis (p<0.01).
- Lateral ECG abnormalities correlated with stenosis in the obtuse marginal branch and proximal LCx.
- Patients with LCx-related infarction, an abnormal R wave in V1, and inferior/lateral Q waves showed larger ventricular volumes, reduced ejection fraction, and more cardiac events.
Conclusions:
- An abnormal R wave in lead V1, especially with lateral ECG abnormalities, is a useful predictor of proximal LCx stenosis.
- This ECG pattern helps identify post-myocardial infarction patients with significant left ventricular dysfunction due to large infarct size.
Abstract:
The relation of electrocardiographic (ECG) patterns to clinical and angiographic features was assessed in 89 patients with isolated left circumflex coronary artery (LCx) disease (46 with and 43 without myocardial infarction). ECG abnormalities were present in 75 patients; there were isolated Q waves in 20, an abnormal R wave in lead V1 with or without inferior and/or lateral Q waves in 21, and isolated ST-T wave changes in 34 cases. Inferior abnormalities on the electrocardiogram were similar in patients with proximal or distal stenoses of the LCx, but an abnormal R wave in lead V1 correlated with proximal LCx stenosis (p less than 0.01). Lateral abnormalities were more common in stenoses of the obtuse marginal branch and proximal LCx than in distal stenosis (all p less than 0.01). Compared with patients without myocardial infarction with or without ST-T-wave changes and those with infarction without an abnormal R wave in lead V1, patients with LCx-related infarction and an abnormal R wave in lead V1 associated with inferior and/or lateral Q waves had larger left ventricular end-diastolic and end-systolic volumes, lower ejection fraction, higher incidence of total occlusion of proximal LCx without collateral vessels, and more cardiac events during follow-up. This study suggests that an abnormal R wave in lead V1 associated with lateral abnormalities on the standard electrocardiogram may be clinically useful in predicting proximal LCx stenosis and identifying a subset of postinfarction patients with left ventricular dysfunction due to a large infarct size.
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