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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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Clinical Significance of V4R ST-Segment Elevation on a Synthesized 18-Lead Electrocardiogram in Patients With

Shingo Watanabe1, Junichi Onuma1, Ryota Ishida1

  • 1Department of Cardiology, Tokyo Yamate Medical Center, Tokyo, Japan.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|April 27, 2026
PubMed

Insights

Synthesized V4R ST-segment elevation in anterior ST-elevation myocardial infarction (STEMI) indicates larger infarct size and higher risk of ventricular tachyarrhythmias and cardiogenic shock. This finding aids in identifying vulnerable patients early.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Acute Coronary Syndromes

Background:

  • Right-sided ST-segment elevation typically signifies inferior myocardial infarction.
  • The clinical relevance of synthesized right-sided ECG leads in anterior STEMI is not well-understood.

Purpose of the Study:

  • To investigate the clinical implications of ST-segment elevation in the synthesized V4R lead among anterior STEMI patients undergoing primary percutaneous coronary intervention (PCI).

Main Methods:

  • Retrospective analysis of anterior STEMI patients who underwent primary PCI with synthesized right-sided ECG leads.
  • Classification of patients based on the presence or absence of ST-segment elevation in the synthesized V4R lead.
  • Comparison of clinical characteristics, angiographic findings, and in-hospital outcomes between groups.

Main Results:

  • Patients with synthesized V4R ST-segment elevation had significantly higher peak creatine kinase levels, suggesting larger infarct size.
  • A higher incidence of ventricular tachyarrhythmias and cardiogenic shock requiring mechanical circulatory support was observed in the V4R-positive group.
  • A right ventricular branch from the left anterior descending artery was more common in patients with V4R elevation.

Conclusions:

  • Synthesized V4R ST-segment elevation in anterior STEMI is linked to larger infarct size and increased risks of ventricular tachyarrhythmias and cardiogenic shock.
  • This ECG finding can help identify patients at high risk for early electrical and hemodynamic instability during myocardial infarction.
Abstract

Keywords:
ST‐segment elevation myocardial infarctionV4Rcardiogenic shockright ventricular infarctionsynthesized 18‐lead electrocardiogramventricular arrhythmia

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