Clinical Implication of ST Segment Depression in aVR &amp;amp; aVL in Patients with Acute Inferior Wall Myocardial Infarction

Ravi Sahi,Rajesh Kumar Shah,Madhu Gupta,Jian Sun,Bhabuk Sharma Majagaiya

doi:10.4236/wjcd.2015.59031

Abstract

Objectives: The aim of the study was to assess the role of ST segment depression in the limb leads aVR and aVL for the diagnosis of acute posterior wall infarction and the identification of infarct related artery (IRA) in patients with acute inferior wall MI. Methods: In 159 patients with I-STEMI, 127 (80%) had RCA occlusion and 32 (20%) had LCX occlusion. In the ECG algorithms, RCA occlusion was indicated by ST depression in lead aVL higher than lead aVR and no ST depression in lead aVL and aVR. LCX occlusion was indicated by ST depression in lead aVR higher than or equal to lead aVL and no ST depression in aVL and aVR. Results: The sensitivity, specificity, positive and negative predictive values of these algorithms were high (98%, 82%, 92% and 95% for RCA occlusion and 83%, 98%, 95% and 92% for LCX occlusion). Conclusion: The ECG algorithms can reliably identify the culprit artery in I-STEMI. ST segment depression in limb leads aVR and aVL with avR ≥ aVL helps to diagnose left circumflex artery as a culprit IRA in an acute inferior wall MI.

Highlights

With no doubt, the electrocardiogram (ECG) is the most useful, feasible, cheap and universally available tool forHow to cite this paper: Sahi, R., Sun, J., Shah, R.K., Gupta, M. and Majagaiya, B.S. (2015) Clinical Implication of ST Segment Depression in aVR & aVL in Patients with Acute Inferior Wall Myocardial Infarction
In the ECG of ST elevation in the inferior leads (II, III and aVF), ST elevation in leads III > II was highly associated with ST depression in lead aVL > aVR than with ST depression in lead aVL ≤ aVR (98% vs 22%) (p =< 0.0001), whereas ST elevation in lead II > III was more associated with ST depression in lead aVL ≤ aVR than aVL > aVR (78% vs 2%) (p =< 0.0001)
In No ST depression in leads aVR and aVL and ST depression in lead aVL > aVR were strongly associated with right coronary artery (RCA) occlusion; 87% and 98% respectively

Summary

Introduction

The electrocardiogram (ECG) is the most useful, feasible, cheap and universally available tool forHow to cite this paper: Sahi, R., Sun, J., Shah, R.K., Gupta, M. and Majagaiya, B.S. (2015) Clinical Implication of ST Segment Depression in aVR & aVL in Patients with Acute Inferior Wall Myocardial Infarction. (2015) Clinical Implication of ST Segment Depression in aVR & aVL in Patients with Acute Inferior Wall Myocardial Infarction. ECG helps to predict the culprit artery and locate the lesion within the infarct related artery (IRA), providing clinically important information to augment clinical decision making and tailor reperfusion therapy [2] [3]. ST segment changes in lead aVR are usually ignored in ECG analysis [5] [6]. The aim of our study was to assess the ST segment depression in limb leads aVR and aVL for the identification of IRA and the diagnosis of inferior wall MI.

Objectives

Methods

Results

Discussion

Conclusion