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[Chronic ventricular aneurysm. The sensitivity and specificity of persistent ST-T elevations on the
U Stierle1, D Börner, A Sheikhzadeh
1Klinik für Kardiologie, Medizinische Universität Lübeck.
Insights
Persistent ST-T elevations on ECG reliably diagnose left-ventricular aneurysm (VA) post-myocardial infarction. Measurements of ST-T elevation characteristics significantly differentiate patients with and without VA.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Left-ventricular aneurysm (VA) diagnosis is crucial after myocardial infarction.
- Standard 12-lead electrocardiogram (ECG) findings require further investigation for VA detection.
Purpose of the Study:
- To evaluate the diagnostic value of persistent ST-T elevations in the standard 12-lead ECG for left-ventricular aneurysm (VA).
- To assess quantitative ECG parameters for differentiating VA presence.
Main Methods:
- Retrospective analysis of 200 patients with prior myocardial infarction.
- Ventriculography used to confirm or exclude left-ventricular aneurysm.
- Analysis of persistent ST-T elevations, including number of leads affected and quantitative measurements (area, height).
Main Results:
- Persistent ST-T elevations showed high sensitivity (93.3%) for VA diagnosis.
- Specificity was 72.6% in patients without VA.
- Quantitative measurements (area, height) of ST-T elevations were significantly different between groups, aiding differentiation.
Conclusions:
- Persistent ST-T elevations on standard 12-lead ECG are valuable for diagnosing left-ventricular aneurysm.
- Quantitative ECG measurements enhance the reliability of VA diagnosis.
- The 12 standard ECG leads are important for VA assessment.
Abstract:
The value of persistent ST-T elevations in the standard 12-lead ECG for the diagnosis of left-ventricular aneurysm (VA) was retrospectively analysed for 200 patients (171 males and 29 females) who had sustained a myocardial infarction at least 12 weeks previously. 105 patients (group 1) had a left-ventricular aneurysm confirmed by ventriculography; in 95 patients (group 2) an aneurysm had been excluded by ventriculography. Persistent ST-T elevations were present in 98 patients of group 1 (sensitivity 93.3%) and in 26 of group 2 (specificity 72.6%). In the 26 patients without VA, ST-T elevations occurred in at most three leads, but in 60 with aneurysm in four to nine leads. In addition, the area under the ST-T elevations and its height 1 mm after onset of the elevation and its maximal height were measured. The sums of the values in the limb and chest leads were statistically significantly different between the two groups for all three parameters. These measurements thus contribute to a reliable differentiation between patients with and without VA. The results also emphasize the importance of the 12 standard leads in the diagnosis of VA.