The Study of Associations of ECG Changes in Lead aVR and Lead V6 with Acute Coronary Syndrome (ACS)

Abstract

BACKGROUND
 The ECG (Electrocardiogram) lead aVR gives reciprocal data for the aVL, II, V5, and V6 leads. It is frequently ignored, even while reviewing complicated ECGs. The purpose of the study was to evaluate the associations of ECG changes in Lead aVR and Lead V6 with acute coronary syndrome (ACS) and coronary complexity as measured by CAG (coronary angiography) in patients with the ACS.
 METHODS
 This was a prospective Hospital-based observational study. A sample size of 80 patients was being used and a study was done on patients admitted to Mahatma Gandhi Medical College & Hospital, Jaipur with ACS, for 18 months, as well as on those who met the inclusion criteria.
 RESULTS
 Of 80 patients enrolled with ACS, the mean age was 60.3500 ± 14.8717 (Mean ± SD). The proportion of patients (72.5 percent) had a history of hypertension, and the prevalence of diabetes in the population was found to be significant. The mean ST elevation in lead aVR of patients was 1.4500 ± 0.6779. The mean ST depression in Lead V6 (Mean ± SD) of patients was 2.1519 ± 0.6063. The mean ST depression in corresponding leads (Mean ± SD) was 2.0375± 0.6303 in patients of ACS. In CAG, 27 (33.8 %) patients had TVD (triple vessel disease), 20 (25.0 %) had DVD (double vessel disease) and 22 (27.5 %) patients had SVD (single-vessel disease). The majority of patients, 46 (57.5 %) had angioplasty, and the distribution of coronary artery bypass graft (CABG) outcomes in the overall population was determined to be significant. ECG changes in leads aVR and V6 correlate with age, lead V1, corresponding leads, troponin levels, and Timi Score (Thrombolysis in Myocardial Infarction). There is a positive association in both leads aVR and V6, and the changes occur concurrently in terms of many parameters, indicating the necessity for additional investigation. The outcomes of our investigation were consistent with the findings of ST-T changes in lead aVR and lead V6.
 CONCLUSIONS
 ECG changes in leads aVR and V6 are associated with poorer prognosis in ACS. Widespread ST-segment depression and ST-segment elevation in lead aVR during episodes of chest pain may represent diffuse subendocardial ischemia caused by severe coronary artery disease (CAD). Further, when interpreting the 12-lead ECG in clinical practice, physicians should give due consideration to the tracing of lead aVR and lead V6 as it can help in identifying the patients who need more aggressive management.