title: Spontaneous myocardial ischemia and the signal-averaged electrocardiogram.
abstract: The effects of transient myocardial ischemia on the signal-averaged electrocardiogram were investigated in 13 patients with coronary artery disease and spontaneous angina undergoing 3-channel ambulatory electrocardiography. Ischemia was seen as ST elevation in 2 patients or ST depression in 11; it was anterior in 5 patients, inferior in 4 and undefined in 4. Signal-averaged electrocardiograms with noise levels less than or equal to 1 microV were obtained from Holter tapes during 54 of 61 ischemic attacks recorded in the study group (88%), and compared with 54 tracings recorded within 60 minutes of the index attacks. Baseline tracings were normal in 8 patients (62%), showed a long QRS duration in 2 (15%), and both a long QRS duration and a late potential in the remaining 3 (23%). Comparison of recordings at baseline and during ischemic attacks revealed no significant changes in signal-averaged electrocardiographic parameters. Absence of significant differences was also noted when analysis was performed according to the type of ischemic attacks (associated with ST elevation [n = 14] or ST depression [n = 40]), their location (anterior [n = 21] or inferior [n = 23]), their duration (greater than 10 minutes [n = 29] or less than or equal to 10 minutes [n = 25]), and their magnitude (greater than 2 mm [n = 18] or less than or equal to 2 mm [n = 36]). It is concluded that spontaneous transient myocardial ischemia, independent of its type, location, duration and magnitude, does not generate a substrate for late potentials on the signal-averaged electrocardiogram.
authors.affiliation: Cardiology Division, San Camillo Hospital, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Turitto
authors.forename: E B
authors.initials: EB
authors.lastname: Caref
authors.forename: E
authors.initials: E
authors.lastname: Zanchi
authors.forename: F
authors.initials: F
authors.lastname: Menghini
authors.forename: G
authors.initials: G
authors.lastname: Kelen
authors.forename: N
authors.initials: N
authors.lastname: el-Sherif
mesh_terms: D000368:Aged; D000703:Analog-Digital Conversion; D000787:Angina Pectoris / Q000503:physiopathology*; D003327:Coronary Disease / Q000503:physiopathology*; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012815:Signal Processing, Computer-Assisted