The de Winter ECG pattern: Distribution and morphology of ST depression
Zhong-Qun Zhan1, Yang Li1, Li-Hong Han1
1Department of Cardiology, Shenzhen Hospital-University of Chinese Academy of Sciences, Shenzhen, China.
Summary
The de Winter ECG pattern effectively predicts acute left anterior descending artery (LAD) lesions, with upsloping ST depression indicating more severe ischemia than nonupsloping patterns.
Area of Science:
- Cardiology
- Electrocardiography
- Emergency Medicine
Background:
- The de Winter ECG pattern's positive predictive value (PPV) for acute left anterior descending artery (LAD) lesions is inconsistent.
- The prognostic significance of upsloping versus nonupsloping ST depression (STD) in this pattern requires clarification.
Purpose of the Study:
- To evaluate the PPV of the de Winter ECG pattern for acute LAD lesions.
- To compare ECG characteristics and clinical significance between different ST depression morphologies.
Main Methods:
- A MEDLINE search identified studies on the de Winter ECG pattern and related terms up to March 2020.
- ECG differences were analyzed based on culprit artery and STD morphology.
Main Results:
- Of 70 patients, 60 had LAD lesions. Maximal STD in V2/V3 showed 89% PPV for LAD lesions (98% in patients without V2-V3 ST elevation).
- Upsloping STD was associated with more frequent q/Q-waves or poor R-wave progression in LAD lesions (84% vs. 27%).
Conclusions:
- Maximal STD location differs between LAD and non-LAD etiologies.
- Upsloping STD morphology suggests more severe ischemic changes compared to nonupsloping STD.
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