DIAGNOSTIC SIGNIFICANCE OF ST-SEGMENT DEPRESSION IN LEAD A VR FOR IDENTIFYING CULPRIT ARTERIES IN INFERIOR WALL ST-ELEVATION MYOCARDIAL INFARCTION
Main Article Content
Keywords
STEMI, lead aVR, ST-segment depression, inferior wall MI, culprit artery, electrocardiogram, LCx, RCA.
Abstract
Introduction: A blockage in either the right coronary artery (RCA) or left circumflex artery (LCx) creates the most frequent cause of inferior wall ST-elevation myocardial infarction (IW-STEMI). The necessity to recognize the affected artery rapidly permits immediate treatment. The measurement of ST segment depression in the lead aVR proves valuable as an indicator during these circumstances.
Objective: The study evaluates whether ST-segment depression in lead aVR helps diagnose the blockage artery for IW-STEMI patients.
Material and Methods: Descriptive cross-sectional research occurred at multi centers including Department of Cardiology, Ayub Teaching Hospital, Abbottabad and Hayatabad Medical Complex, Peshawar in the duration from January, 2023 to December, 2023. The research analysis included 150 IW-STEMI patient participants. Experts examined the ST depression in lead aVR through ECGs to find correlations with angiographic results.
Result: The diagnosis of Left Coronary Artery blockage with ST depression in lead aVR showed 88.6% sensitivity while offering 55.0% specificity. The evidence shows that when lead aVR displays depressed waves, it suggests that the LCx artery is blocked (p<0.001).
Conclusion: A valuable diagnostic indicator for LCx artery involvement exists in ST depression found in lead aVR during IW-STEMI.
References
2- Raza, A., Ali, F., Bano, N., Ali, M., Fazal, A. and Fazal, K., 2023. Culprit Arteries in Patients with Inferior Wall Myocardial Infarction (IWMI) With St Segment Depression in Lead AVR: Culprit Arteries in Patients with Inferior Wall Myocardial Infarction. Pakistan Journal of Health Sciences, pp.145-148.
3- Barbosa, R.R., Bragatto, I.C. and Muzi, R.R., 2024. Inferior Wall ST-Segment Elevation Myocardial Infarction (STEMI): Identifying The Culprit Artery from The Electrocardiogram. Cardiol Vasc Res, 8(2), pp.1-6.
4- Zheng, X., Zhang, Z., Yao, B. and Wu, H., 2024. Electrocardiographic findings for predicting the left anterior descending artery chronic total occlusion in patients with inferior ST-segment elevation myocardial infarction. Scientific Reports, 14(1), p.29112.
5- Saber Mohamed Osman, M., Abd El-Sallam, S.A.D. and El-Tayeb, A., 2024. SIGNIFICANCE OF ST-SEGMENT DEVIATION IN STANDARD ECG FOR PREDICTION OF CULPRIT ARTERY IN ACUTE INFERIOR WALL ST-ELEVATION MYOCARDIAL INFARCTION. Al-Azhar Medical Journal, 53(1), pp.73-84.
6- Joseph, J. and Menon, J.C., 2021. The sensitivity and specificity of electrocardiogram in localizing the culprit artery with angiographic correlation in Indian patients with acute ST-segment elevation myocardial infarction. Journal of Indian College of Cardiology, 11(2), pp.70-81.
7- Simkhada, R., Khan, B., KC, S.S., Budhathoki, A., Adhikari, K.C. and Baral, B.R., 2021. Angiographic Significance of ST Depression in Anterior Leads in Acute Inferior ST Elevation Myocardial Infarction. Nepalese Heart Journal, 18(2), pp.7-10.
8- Singh, A., Dwivedi, S., Pradhan, A., Narain, V.S., Sethi, R., Chandra, S., Vishwakarma, P., Chaudhary, G., Bhandari, M. and Sharma, A., 2021. Isolated ST‐Elevation Myocardial Infarction Involving Leads I and aVL: Angiographic and Electrocardiographic Correlations from a Tertiary Care Center. Cardiology Research and Practice, 2021(1), p.7638020.
9- Tseng, L.M., Chuang, C.Y., Chua, S.K. and Tseng, V.S., 2022. Identification of coronary culprit lesion in ST elevation myocardial infarction by using deep learning. IEEE Journal of Translational Engineering in Health and Medicine, 11, pp.70-79.
10- Aslan, B. and Karahan, M.Z., 2022. The Relationship Between ST-Segment Depression in Lead aVR and Coronary Microvascular Function in Acute Inferior Myocardial Infarction. Acta Medica, 53(1), pp.53-58.
11- Sharma, S.K., 2021. Status of Emergent Reperfusion Therapy in Patients with Acute Coronary Syndrome Having ST Depression in Right Precordial Leads with Non-Reassuring ST Elevation in Posterior Leads. Journal of Cardiovascular Disease Research, 12(3), pp.480-490.
12- Meyers, H.P., Bracey, A., Lee, D., Lichtenheld, A., Li, W.J., Singer, D.D., Rollins, Z., Kane, J.A., Dodd, K.W., Meyers, K.E. and Shroff, G.R., 2021. Ischemic ST‐segment depression maximal in V1–V4 (versus V5–V6) of any amplitude is specific for occlusion myocardial infarction (versus nonocclusive ischemia). Journal of the American Heart Association, 10(23), p.e022866.
13- Aly Ahmed, A.M., Al–Zayat, A.A.E., Abdelsamei, M.M., Allam, M.M. and Mohamed, M.M., 2024. Electrocardiographic Distinction of Culprit Artery in Patients with Acute Inferior ST Segment Elevation Myocardial Infarction and Multivessel Disease. Zagazig University Medical Journal, 30(3), pp.927-934.
14- Zheng, X.B., Wu, H.Y., Zhang, M. and Yao, B.Q., 2024. Clinical significance of R‐wave amplitude in lead V1 and inferobasal myocardial infarction in patients with inferior wall myocardial infarction. Annals of Noninvasive Electrocardiology, 29(3), p.e13114.
15- Wu, L., Huang, G., Yu, X., Ye, M., Liu, L., Ling, Y., Liu, X., Liu, D., Zhou, B., Liu, Y. and Zheng, J., 2022. Deep learning networks accurately detect ST-segment elevation myocardial infarction and culprit vessel. Frontiers in cardiovascular medicine, 9, p.797207.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Mohsin Iqbal
Department of Cardiology, Ayub Teaching Hospital, Abbottabad, Pakistan
Dr. Farhat Ullah Khan
Department of Cardiology, Hayatabad Medical Complex, Peshawar, Pakistan
Dr. Ayesha Bibi
Department of Cardiology, Ayub Teaching Hospital, Abbottabad, Pakistan
Dr. Naeem Khan
Department of Cardiology, Hayatabad Medical Complex, Peshawar, Pakistan
Dr. Muhammad Idrees Khan
Department of Cardiology, Hayatabad Medical Complex, Peshawar, Pakistan
Dr. Rahim Dil Khan
Fellow Interventional Cardiology, Hayatabad Medical Complex, Peshawar, Pakistan