Selective cine coronary arteriography and vectorcardiographic diagnoses: Correlative study of one hundred patients

Abstract

One hundred patients were studied with cine coronary arteriography and vectorcardiograms (VCG's). Coronary artery narrowing was estimated and correlated with vectorcardiographic diagnoses of myocardial infarcts and/or fibrosis. An anatomically and physiologically derived computer model of the myocardium was used as a means of interpreting the spatial VCG with regard to the size and site of destructive lesions within 12 myocardial subdivisions. Standard VCG criteria for large myocardial infarcts as well as new criteria for identification of smaller lesions were compared with coronary arteriographic findings. Myocardial lesions were identified as “scallops” in the QRS-E loop and their size was estimated by the magnitude and duration of deviation from a smooth progression of the VCG loop. A significant statistical correlation was found between the presence of severe coronary artery disease and vectorcardiographic evidence of large myocardial infarcts. VCG diagnoses of “small” and “medium” lesions had no statistical correlation with hemodynamically significant coronary artery disease. There was no significant statistical correlation between coronary arteriographic findings and VCG localization of infarcts. This is most likely due to anatomical variation in regional arterial supply and collateral vessel formation and is supported by a previous observation that the degree of coronary arteriographic change is inconsistent with the degree of ventricular dysfunction as demonstrated by ventricular angiograms. The VCG appears to be a useful clinical adjunct in the diagnosis of severe coronary artery disease and large myocardial infarcts. However, there is no evidence that smaller lesions predicted by VCG relate to the size or location of small scars in the myocardium.