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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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Significance of ST-Segment elevation in V4R lead in patients with anterior myocardial infarction

Pooyan Dehghani1, Ali Zahedi1, Mani Hassanzadeh1

  • 1Shiraz University of Medical Sciences, Shiraz, Iran.

Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
|June 5, 2021
PubMed

Insights

ST-segment elevation in the V4R lead is associated with anterior myocardial infarction, often occurring with V1 lead elevation. This finding indicates a higher likelihood of reduced left ventricular ejection fraction and proximal left anterior descending artery involvement.

Area of Science:

  • Cardiology
  • Electrocardiography
  • Myocardial Infarction

Background:

  • The association between ST-segment elevation in the V4R lead and anterior wall myocardial infarction (MI) is suggested but not fully understood.
  • The link between V4R ST elevation and the extent/severity of coronary artery disease in anterior MI patients requires further investigation.

Purpose of the Study:

  • To investigate ST-segment elevation in V4R leads in patients diagnosed with anterior MI.
  • To determine the effect of V4R ST elevation on prognosis and its role in detecting coronary artery stenosis location via angiography.

Main Methods:

  • Retrospective review of hospital records for 195 patients with suspected acute MI, presenting within 2 hours of symptom onset.
  • Patients were classified into two groups: those with and without ST elevation in the V4R lead.

Main Results:

  • Concurrent ST-segment elevation in the V1 lead was significantly more frequent in patients with V4R ST elevation.
  • Lower left ventricular ejection fraction (LVEF <40%) was observed in 74% of patients with V4R ST elevation versus 35.2% without.
  • Proximal lesions in the left anterior descending artery (LAD) were more prevalent in the V4R ST elevation group.

Conclusions:

  • ST-segment elevation in the V4R lead frequently co-occurs with ST elevation in the V1 lead.
  • V4R ST elevation in anterior MI patients is linked to poorer prognosis, indicated by lower LVEF, larger infarct size, and involvement of the proximal LAD, including "wrap-around" LAD lesions.
Abstract

Keywords:
ST elevationV4R leadmyocardial infarction

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