Performance of ST and ventricular gradient difference vectors in electrocardiographic detection of acute myocardial
Roderick W Treskes1, C Cato Ter Haar1, Sumche Man1
1Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Insights
Serial electrocardiogram (ECG) analysis of ST and ventricular gradient (VG) vectors can improve the diagnosis of acute myocardial ischemia. This method shows equal or superior performance compared to ST-elevation myocardial infarction (STEMI) criteria.
Area of Science:
- Cardiology
- Medical Diagnostics
- Electrocardiography
Background:
- Acute coronary occlusion can cause myocardial ischemia, which is challenging to diagnose using standard ECG methods.
- Serial ECG analysis offers a potential improvement for diagnosing myocardial ischemia.
Purpose of the Study:
- To evaluate the diagnostic performance of serial ECG analysis of ST and ventricular gradient (VG) vectors for detecting acute myocardial ischemia.
- To compare the efficacy of serial ECG analysis with conventional ST-elevation myocardial infarction (STEMI) criteria.
Main Methods:
- ECG pairs from 84 cases and 398 controls were analyzed.
- ST and VG vectors were computed for each ECG, and difference vectors (ΔST, ΔVG) were calculated.
- Receiver operating characteristic (ROC) analysis was performed to assess diagnostic accuracy.
Main Results:
- Serial analysis of ΔST and ΔVG vectors demonstrated high diagnostic performance (AUCs 0.906 and 0.880, respectively).
- Serial ECG analysis achieved higher specificity (96.5% for ΔST) compared to STEMI criteria (89.1%) at matched sensitivity.
- Sensitivity for serial analysis (78.6% for ΔST) was comparable to STEMI criteria (70.2%).
Conclusions:
- Serial ECG analysis of ST and VG vectors is a valuable tool for diagnosing acute myocardial ischemia.
- This approach performs comparably or better than current STEMI criteria.
- Further validation in triage settings for patients with suspected acute myocardial ischemia is recommended.
Introduction:
Serial analysis could improve ECG diagnosis of myocardial ischemia caused by acute coronary occlusion.
Methods:
We analyzed ECG pairs of 84 cases and 398 controls. In case-patients, who underwent elective percutaneous coronary intervention, ischemic ECGs during balloon occlusion were compared with preceding non-ischemic ECGs. In control-patients, two elective non-ischemic ECGs were compared. In each ECG the ST vector at the J point and the ventricular gradient (VG) vector was computed, after which difference vectors ΔST and ΔVG were computed within patients. Finally, receiver operating characteristic analysis was done.
Results:
Areas under the curve were 0.906 (P<0.001; CI 0.862-0.949; SE 0.022) for ΔST and 0.880 (P<0.001; CI 0.833-0.926; SE 0.024) for ΔVG. Sensitivity and specificity of conventional ST-elevation myocardial infarction (STEMI) criteria were 70.2% and 89.1%, respectively. At matched serial analysis specificity and STEMI specificity, serial analysis sensitivity was 78.6% for ΔST and 71.4% for ΔVG (not significantly different from STEMI sensitivity). At matched serial analysis sensitivity and STEMI sensitivity, serial analysis specificity was 96.5% for ΔST and 89.3% for ΔVG; ΔST and STEMI specificities differed significantly (P<0.001).
Conclusion:
Detection of acute myocardial ischemia by serial ECG analysis of ST and VG vectors has equal or even superior performance than the STEMI criteria. This concept should be further evaluated in triage ECGs of patients suspected from having acute myocardial ischemia.
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