Early ischemic ST-segment and T-wave changes during balloon angioplasty
Mazal-Anna Pessah1, Heini Huhtala2, Petteri Kosonen3
1Tampere University, Faculty of Medicine and Health Technology, Finnish Cardiovascular Research Center, Tampere, Finland.
Insights
Continuous ECG monitoring during coronary artery occlusion reveals distinct ST and T-wave changes. Left circumflex artery occlusion shows the most significant differences in ST and T-wave amplitudes, indicating localized ischemia.
Area of Science:
- Cardiology
- Electrophysiology
- Ischemic Heart Disease
Background:
- Acute coronary occlusion causes characteristic ECG changes, including ST-segment elevation and increased T-wave amplitude.
- These electrocardiogram (ECG) changes are typically observed in leads facing the affected ischemic region.
Purpose of the Study:
- To investigate and compare ST and T-wave amplitude changes during acute coronary occlusion in different coronary arteries.
- To analyze the diagnostic significance of these ECG changes in localizing myocardial ischemia.
Main Methods:
- Continuous 12-lead ECG recordings were performed in 34 patients during balloon occlusion of the left anterior descending (LAD), left circumflex (LCx), and right coronary artery (RCA).
- Delta (Δ) ST and ΔT amplitudes were calculated by subtracting pre-inflation values from values during balloon inflation to quantify changes.
Main Results:
- Left anterior descending (LAD) occlusion led to a greater increase in T-wave amplitude than ST-segment amplitude in lead V2.
- Right coronary artery (RCA) occlusion showed no significant difference between ΔST and ΔT.
- Left circumflex (LCx) occlusion demonstrated significant differences between ΔST and ΔT in most leads, with rare biphasic ST-T responses observed.
Conclusions:
- Continuous ECG monitoring during LCx occlusion reveals significant differences between ST-segment and T-wave changes, aiding in ischemia localization.
- LAD and RCA occlusions showed less pronounced differences between ST-segment and T-wave changes.
- Changes in T-wave polarity during occlusion were found to be infrequent.
Background:
Acute coronary occlusion results in increased T-wave amplitude and ST-segment elevation in the ECG leads facing the ischemic region.
Material And Methods:
We performed continuous ECG recording in 34 patients during balloon occlusion of the left anterior descending (LAD), left circumflex (LCx) and right coronary artery (RCA). Delta (Δ) ST and ΔT amplitudes were calculated by subtracting the preinflation values from the values measured during balloon inflation.
Results:
Occlusion of the LAD resulted in greater increase in the amplitude of the T wave than of the ST segment in lead V2 (ΔT +3.4 mm, inter-quartile range [IQR] 1-6 mm; ΔST +1.4 mm, 0.5-3 mm). During RCA occlusion, ΔST and ΔT didn't differ significantly. LCx occlusion resulted in significant differences between ΔST and ΔT in all leads, except aVF and V3-V4. In two patients (LCx), we observed a biphasic ST-T response: an initial negative change of the T-wave amplitude was followed by a positive change in leads V1-V2. In leads II, III, aVF and V4-V6, there was an initial positive change, followed by a final negative change towards the end of the occlusion.
Conclusion:
Continuous 12‑lead ECG recording during balloon occlusion of the LCx resulted in significant differences between the ΔST and ΔT values in all leads except aVF and V3-V4. LAD and RCA occlusion resulted in less evident differences between the ST-segment and T-wave changes. A change in polarity of T-wave changes during balloon occlusion (initial negative and final positive change, or vice versa) proved to be a rare finding.
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