Electrocardiographic ST-segment monitoring during controlled occlusion of coronary arteries.
BACKGROUND
Ischemia monitoring cannot always be performed by 12-lead ECG. Hence, the individual performance of the ECG leads is crucial. No experimental data on the ECG's specificity for transient ischemia exist.


METHODS
In 45 patients a 19-lead ECG was registered during a 1-minute balloon occlusion of a coronary artery (left anterior descending artery [LAD], right coronary artery [RCA] or left circumflex artery [LCX]). ST-segment shifts and sensitivity/specificity of the leads were measured.


RESULTS
During LAD occlusion, V3 showed maximal ST-segment elevation (0.26mV [IQR 0.16-0.33mV], p=0.001) and sensitivity/specificity (88% and 80%). During RCA occlusion, III showed maximal ST-elevation (0.2mV [IQR 0.09-0.26mV], p=0.004), aVF had the best sensitivity/specificity (85% and 68%). During LCX occlusion, V6 showed maximal ST-segment elevation (0.04mV [IQR 0.02-0.14mV], p=0.005), and sensitivity/specificity was (31%/92%) but could be improved (63%/72%) using an optimized cut-off for ischemia.


CONCLUSIONS
V3, aVF and V6 show the best performance to detect transient ischemia.
Department of Cardiology, Bern University Hospital, Bern, Switzerland; ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland.
Andreas
A
Haeberlin
Department of Cardiology, Bern University Hospital, Bern, Switzerland; ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland.
Evelyn
E
Studer
ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland; Institute of Human Centered Engineering, Bern University of Applied Sciences, Bern, Switzerland.
Thomas
T
Niederhauser
Department of Cardiology, Bern University Hospital, Bern, Switzerland.
Michael
M
Stoller
ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland; Institute of Human Centered Engineering, Bern University of Applied Sciences, Bern, Switzerland.
Thanks
T
Marisa
Institute of Human Centered Engineering, Bern University of Applied Sciences, Bern, Switzerland.
Josef
J
Goette
Institute of Human Centered Engineering, Bern University of Applied Sciences, Bern, Switzerland.
Marcel
M
Jacomet
Department of Cardiology, Bern University Hospital, Bern, Switzerland.
Tobias
T
Traupe
Department of Cardiology, Bern University Hospital, Bern, Switzerland.
Christian
C
Seiler
Department of Cardiology, Bürgerspital Solothurn, Solothurn, Switzerland. Electronic address: rolf.vogel@spital.so.ch.
Rolf
R
Vogel
D000368:Aged; D000465:Algorithms; D054059:Coronary Occlusion / Q000150:complications* / Q000175:diagnosis*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
Coronary occlusion; ECG; ST-segment monitoring