Comparative analysis of ischemic changes in electrocardiogram and coronary angiography results: A retrospective study
Yun Liu1, Jing Ping1, LiCheng Qiu1
1Qingdao Starr Heart Hospital, Qingdao 266011.
Insights
Electrocardiogram (ECG) ST-T ischemic changes aid coronary heart disease diagnosis. Conventional ECG shows higher sensitivity, while dynamic ECG (DECG) offers better specificity, especially in women and the elderly.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Coronary heart disease (CHD) diagnosis relies on various methods.
- Electrocardiogram (ECG) ST-T ischemic changes are potential indicators.
- Improving diagnostic accuracy for CHD is crucial.
Purpose of the Study:
- To enhance the correct diagnosis rate of coronary heart disease.
- To evaluate the diagnostic value of ECG ST-T ischemic changes.
Main Methods:
- Retrospective analysis of 310 patients undergoing conventional ECG, dynamic ECG (DECG), and coronary angiography (CA).
- Evaluation of ST-T ischemic changes using standard criteria and Judkins criteria for CA.
- Analysis of sensitivity, specificity, and likelihood ratios of ECG findings.
Main Results:
- Conventional ECG sensitivity: 66.0%, specificity: 33.7%.
- DECG sensitivity: 32.2%, specificity: 55.6%.
- DECG showed slightly higher sensitivity in women and the elderly; ST-T changes were more significant in men.
Conclusions:
- Conventional ECG offers higher sensitivity, while DECG provides better specificity for CHD diagnosis.
- ST-T ischemic changes are more indicative in male patients.
- Hypertension, diabetes, smoking, and family history are significant risk factors for CHD.
Abstract:
To improve the correct diagnosis rate of coronary heart disease and to explore the guiding value of electrocardiogram (ECG) ST-T ischemic changes in the clinical diagnosis of coronary heart disease.A retrospective analysis was conducted on a total of 310 cases who underwent a conventional 12-lead ECG, 12-lead dynamic ECG (DECG, Holter) with ST-T ischemic changes, and then coronary angiography (CA) within 1 week in Qingdao Sttarr Heart Hospital from June 2015 to April 2020 in the study. Ischemic ST-T changes were evaluated using conventional diagnostic criteria, and Judkins diagnostic criteria were used in CA. The sensitivity and specificity of ECG were analyzed.The specificity of ST-T changes in conventional ECG for the diagnosis of coronary heart disease is 33.7% and the sensitivity is 66.0%. The specificity of ST-T changes in Holter in the diagnosis of coronary heart disease is 55.6% and the sensitivity is 32.2%. The sensitivity of conventional ECG for the diagnosis of coronary heart disease is better than Holter, but its specificity is inferior to Holter. The negative likelihood ratios of the 2 ECGs for the diagnosis of coronary heart disease were 1.0 and 1.22, both >0.1, and the positive likelihood ratios were 0.99 and 0.73, both <10. The positive results of ST-T in conventional ECG were 128 males (65.7%), 77 females (66.9%), (P < .05), 148 cases (74.7%) in the group ≥60 years old, and 75 cases in the group less than 60 years (67%), (P > .05). The positive results of ST-T change of DECG were 135 males (69.2%), 69 females (60.0%), (P < .05), 152 cases (78.7%) in the group ≥60 years, and 83 cases (70.9%) in the group less than 60 years, (P > .05). Coronary heart disease-related factors: symptoms, hypertension, diabetes, cancer, family history, smoking history as independent variables, and a binary multivariate logistic regression analysis was performed.The sensitivity of DECG in the diagnosis of myocardial ischemia in women and the elderly was slightly higher than that in men and young cases. ST-T ischemic changes in ECG are more significant for the diagnosis of coronary heart disease in male patients. Smoking, hypertension, diabetes, and family history are all high-risk factors for coronary heart disease.
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