Value Of ST-segment Depression Research Articles

Correlation of Sum of ST Segment Depression in Leads V1 to V4 in Acute Inferior Myocardial Infarction with Angiographic Severity of Coronary Artery Disease

Background: Inferior wall acute myocardial infarction accounts for 40 to 50% of all acute STEMI. Patients of acute inferior myocardial infarction with ST depression in lateral leads often have greater incidence of triple vessel disease and proximal RCA lesion but in case of patients of acute inferior myocardial infarction with ST depression in precordial leads (leads V1 to V4), is a subject of determination whether it is associated with more sever coronary artery disease. The aim of this study is to determine the association of sum of ST depression in precordial leads with the probability of concomitant severity of coronary artery disease in patients with acute inferior STEMI. Methods: this cross sectional observational study was done at National institute of cardiovascular diseases (NICVD), Dhaka, Bangladesh. Total 90 patients of acute inferior myocardial infarction with precordial lead ST depression admitted at CCU within 12 hours of onset of chest pain were the study population. They were divided in two groups on the basis of sum of ST depression in precordial leads (Sum of ST depression d”4mm and >4mm), 36 patients in group I and 54 patients in group II. Coronary angiography was performed during the index hospitalization period. Gensini score and Reardon score were measured. Results: Overwhelming majority of the patients was male (83.3% and 90.7%) with mean age of 51.0±9.7 and 51.0±9.9 years in group I and II respectively. Smoking, hypertension and diabetes mellitus were the most frequent risk factors in both groups. Serum troponin level was significantly high in group II (6.2±2.2 vs. 13.6±17.7, p <0.05). Sum of ST depression in precordial leads was 2.84±0.66 and 7.53±3.51 in group I and group II respectively, and was statistically significant. Consideration of mean of ST depression in individual leads shows significantly higher mean in leads V2, V3 and V4 among group II patients. SVD was more frequent in group I but group II patients had higher statistically significant incidence of DVD and TVD. Gensini score (20.26±13.0 vs. 36.98±16.9) and Reardon score (4.63±2.2 vs. 6.83±2.2) was high in group II patients. Positive correlation had been depicted between summation value of ST segment depression with that of Gensini score & Reardon score (Gensini score r=0.61 and Reardon score r= 0.52). Conclusion: Involvement Triple vessel and double vessel disease was remarkably higher with increasing sum of ST segment depression in precordial leads. The severity of ST segment depression in terms of summation of ST depression in leads V1 to V4 is directly proportional to the extent and severity of coronary artery disease. Bangladesh Heart Journal 2022; 37(2): 116-121

Characteristics and mechanism of reciprocal ST-segment depression in acute ST segment elevation myocardial infarction: Reciprocal ST-segment depression and ST segment elevation myocardial infarction.

At present, the mechanism of reciprocal ST-segment depression (RSTD) is unclear. ST-segment changes may be caused by the potential difference between the positive and negative electrodes, although this requires further investigation. The characteristics of RSTD and their relationship with ST-segment elevation in acute ST segment elevation myocardial infarction (STEMI) patients were analyzed. We replaced the negative electrode of the precordial leads of an inferior wall myocardial infarction patient and observed the changes in the ST-segment of the precordial leads. A total of 85 patients were included, of which 75 were patients with RSTD. All 45 patients with inferior myocardial infarction had limb lead RSTD, and 37 had anterior lead ST-segment depression. All ST-segment changes in STEMI can be explained by the proposed mechanism, and the value of ST segment depression in limb leads can be calculated by the value of ST segment elevation. In summary, the mechanism of RSTD in acute myocardial infarction may be that the action potential (AP) of the negative electrode of the lead weakens or disappears and the AP of the positive electrode may not be completely offset, resulting in ST-segment depression. Animal experimental studies are needed for further confirmation. When the negative electrode of the precordial lead is changed in acute inferior wall myocardial infarction patient, the ST-segment of the precordial lead changes accordingly. All the changes are consistent with our analysis.

Clinical significance and prognostic value of ST segment depression on ECG during exercise treadmill test in asymptomatic patients with moderate or severe aortic stenosis

Objectives. In patients with asymptomatic moderate or severe aortic stenosis (AS), exercise testing is used for evaluating the need for aortic valve intervention. Expert opinions about the clinical significance and prognostic value of ST segment depression on electrocardiography (ECG) during exercise testing in AS is conflicting and there are no large studies exploring this issue. We aimed to explore the association of ST segment depression >5 mm during exercise treadmill test (ETT) with all-cause mortality, aortic valve replacement (AVR) or cardiac-related hospitalization. Design. We performed a retrospective analysis of prospectively collected data of a total of 315 patients (mean age 65 ± 12 years, 67% men) with asymptomatic moderate (n = 209; 66%) or severe (n = 106; 34%) AS. All patients underwent clinical evaluation, echocardiography and ETT. Results. During a mean follow-up of 34.9 ± 34.6 months, 29 (9%) patients died and 235 (74%) underwent AVR. The prevalence of ST segment depression (>5 mm) was 13% (n = 41) in the total study population and was comparable in patients with revealed symptoms (17.6%, n = 16) versus without revealed symptoms (11.3%, n = 25; p = .132). ST segment depression on ETT was strongly associated with aortic valve area. In univariate Cox regression analysis, ST segment depression was not associated with cardiac related hospitalizations (HR 1.65; 95% CI 0.89–3.10, p = .113), all-cause mortality (HR 1.37; 95% CI 0.47–3.98, p = .564) or AVR (HR 1.30; 95% CI 0.89–1.91, p = .170). Conclusion. In patients with moderate or severe AS, ST segment depression during ETT is non-specific, carries no prognostic risk and should be used with caution in the clinical interpretation of exercise test.

The Value Of St Segment Depression In The Middle Aged And Elderly People With Different Level Of Vascular Hardness During Gxt

The Value Of St Segment Depression In The Middle Aged And Elderly People With Different Level Of Vascular Hardness During Gxt

What is the predictive value of ST segment depression in inferior leads in first acute anterior myocardial infarction?

BackgroundElectrical phenomenon and remote myocardial ischemia are the main factors of ST segment depression in inferior leads in acute anterior myocardial infarction (AAMI). We investigated the prognostic value of the sum of ST segment depression amplitudes in inferior leads in patients with first AAMI treated with primary percutaneous coronary intervention. (PPCI). MethodsIn this prospective analysis, we evaluated the in-hospital prognostic impact of the sum of ST segment depression in inferior leads on 206 patients with first AAMI. Patients were stratified by tertiles of the sum of admission ST segment depression in inferior leads. Clinical outcomes were compared between those tertiles. ResultsUnivariate analysis revealed higher rate of in-hospital death for patients with ST segment depression in inferior leads in tertile 3, as compared to patients in tertile 1 (OR 9.8, 95% CI 1.5–78.2, p<0.001). After adjustment for baseline variables, ST segment depression in inferior leads in tertile 3 was associated with 5.7-fold hazard of in-hospital death (OR: 5.7, 95% CI 1.2–35.1, p<0.001). Spearman rank correlation test revealed correlation between the sum of ST segment depression amplitude in inferior leads and the sum of ST segment elevation amplitude in V1–6, L1 and aVL. Multivessel disease and additional RCA stenosis were also detected more often in tertile 3. ConclusionThe sum of ST segment depression amplitude in inferior leads of admission ECG in patients with first AAMI treated with PPCI provide an independent prognostic marker of in-hospital outcomes. Our data suggest the sum of ST segment depression amplitude to be a simple, feasible and clinically applicable tool for rapid risk stratification in patients with first AAMI.

Limited value of recovery phase-limited ST segment depression of treadmill exercise test

Background Clinical meaning of recovery phase limited ST segment depression of a treadmill exercise test is controversial. The aim of this study was to re-assess the diagnostic and prognostic value of ST segment depression during the recovery phase with the active phase of a treadmill exercise test in suspected coronary artery disease patients. Methods Clinical, exercise and angiographic data were retrospectively collected from 602 patients in the study. Five hundred and seventy-six patients developed ST segment depression during the active phase of the treadmill exercise test (group 1) and 26 patients developed ST segment depression only during the recovery phase (group 2). Results With similar major clinical features, the prevalence of significant coronary artery stenosis and average Gensini scores were lower in the recovery phase-limited depression patients (group 2 vs. group 1, 50.0% vs. 66.9%, P=0.031 and group 2 vs. group 1, 1.5 vs. 8.5, P=0.04). At a median follow up of 50.9 months for 22 group 2 and 34.8 months for 438 group 1 patients, the prevalence of total cardiac events was higher in group 1 than in group 2 patients (RR 1.60, 95% CI 1.00-2.54, P=0.049). Conclusion The present study provides preliminary evidence that the diagnostic and prognostic value of recovery phase-limited ST segment depression of treadmill exercise test is limited. Chin Med J 2014;127 (4): 742-746

Prognostic Value of Myocardial Ischemic Electrocardiographic Response in Patients With Normal Stress Echocardiographic Study

The prognostic value of ST-segment depression on exercise electrocardiogram (eECG) in the setting of a normal wall motion response in a stress echocardiographic study is not well defined. The aim of the study was to compare outcomes among patients with normal wall motion during stress echocardiography with and without ischemic exercise electrocardiographic changes. A total of 4,233 patients underwent stress echocardiography from 2007 to 2010. The primary outcomes were a composite of all-cause mortality and myocardial infarction. Coronary revascularization was a secondary outcome. A Cox regression model was used for the primary analysis. Ischemic exercise electrocardiographic changes were defined as ST-segment depression of at least 1 mm, on at least 3 consecutive beats, and in at least 2 contiguous leads. A normal stress echocardiogram was present in 2,975 patients; of them, 2,228 (74%) had a normal eECG and 747 (26%) had ischemic changes on eECG. Patients with and without ischemic changes during exercise electrocardiography were similar in age and gender. At 4-years follow-up, 36 patients (2.8%) with a normal eECG experienced a primary end point versus 12 patients (1.9%) in the group with an ischemic exercise electrocardiographic response (p = 0.56). The rate of coronary revascularization was similar between the groups (7.0% and 5.7%, respectively, p = 0.2). There were no differences in the primary outcomes of patients with and without exercise electrocardiographic changes and normal stress echocardiogram (hazard ratio 1.33, 95% confidence interval 0.69 to 2.58). In conclusion, a normal wall motion response even in the setting of an ischemic exercise electrocardiographic response portends a benign prognosis in patients undergoing stress echocardiography.

Comparative prognostic value of T-wave inversion and ST-segment depression on the admission electrocardiogram in non–ST-segment elevation acute coronary syndromes

ST-segment depression (STD) is predictive of adverse outcomes in non-ST-segment elevation acute coronary syndromes (NSTE-ACS), but there are conflicting data on the incremental prognostic value of T-wave inversions (TWIs) on the admission electrocardiogram. Admission electrocardiograms of 7,343 patients with NSTE-ACS from the Global Registry of Acute Coronary Events (GRACE) and ACS I registry were independently analyzed at a core laboratory and stratified by TWI and STD status. We performed multivariable analyses to determine the independent prognostic significance of TWI and tested for interaction between TWI and STD for adverse outcomes. Patients with TWI and/or STD had a higher prevalence of cardiovascular risk factors, higher Killip class, and higher GRACE risk scores. Among the 2,708 patients with available angiographic data, rates of 3-vessel or left main disease were similar between patients with TWI and those without TWI/STD. After adjusting for other established prognosticators, TWI did not independently predict in-hospital (adjusted odds ratio 1.03, 95% CI 0.75-1.42, P = .85) or 6-month mortality (adjusted odds ratio 1.02, 95% CI 0.80-1.30, P = .88); STD remained a strong independent predictor. There was no interaction between TWI and STD for these outcomes. No contiguous lead groups or cumulative number of leads with TWI provided independent prognostic information. TWI is associated with other high-risk clinical features but is not an independent predictor of adverse short- and long-term mortality in NSTE-ACS. T-wave inversion does not provide additional prognostication beyond the GRACE risk model, and its concomitant presence does not alter the prognostic value of STD.

Value of ST Segment Changes in 12 Lead ECG to Detect Proximal Versus Distal Right Coronary Artery Occlusion in Acute Inferoposterior Myocardial Infarction

Background: A history of ischemic-type discomfort &amp; the initial 12- lead ECG are the primary tools for screening patients with acute myocardial infarction in the emergency department. ST elevation in inferior leads indicates an evolving myocardial infarction of the inferoposterior wall. The outcome of patients with inferoposterior myocardial infarction due to occlusion of right coronary artery depends mainly on the location of occlusion (distal versus proximal). Hypothesis: Value of ST-segment depression in lateral leads (I and aVL) and ST-segment changes in lead V1 to predict the site of right coronary artery occlusion in the case of an inferoposterior myocardial infarction. Objective: To predict the site of right coronary artery (RCA) occlusion ( proximal or distal) in acute inferoposterior myocardial infarction by ST segment depression in leads 1 &amp; aVL and ST-segment changes( is electric/ elevated or depressed) in V1.Methods and Results: A total of fifty four patients of ST-segment elevation inferoposterior wall AMI due to suspected RCA occlusion, admitted within 12 hours of onset of chest pain, and subsequently underwent coronary angiography during hospitalization, were selected for the study. Patients were divided into two groups on the basis of angiographic findings: proximal RCA occlusion (group I) and distal RCA occlusion (group II). A 12 lead ECG was taken on admission. ST segment deviation in lateral leads (I &amp; aVL) as well as in precordial lead (V1) was calculated. Isoelectric or elevated ST-segment in V1 predicted proximal RCA occlusion whereas depressed ST-segment predicted distal RCA occlusion. It was demonstrated that, STsegment changes in precordial lead (V1) was a sensitive &amp; specific marker to discriminate proximal &amp; distal RCA occlusion in inferoposterior wall AMI with high positive &amp; negative predictive value, but ST-segment changes in lateral leads (I &amp; aVL) although more specific for proximal RCA occlusion did not seem to be of clinical value due to its low sensitivity. DOI: http://dx.doi.org/10.3329/uhj.v7i2.10844 University Heart. Journal Vol. 7, No. 2, July 2011

Usefulness of ST segment depression limited to the recovery phase of exercise stress test.

To determine the diagnostic value of ST segment depression limited to recovery phase of Exercise Tolerance Test (ETT). An observational cross-sectional study. The study was carried out at Punjab Institute of Cardiology, Lahore, from March to August 2007 for a period of 6 months. In this study, 100 patients were selected with purposive non-probability sampling technique and were divided into two groups, group A having ST segment depression during exercise phase of ETT, and group B having ST segment depression only in recovery phase after undergoing ETT according to Bruce protocol. The patients were subjected to coronary angiography later on. The chi-square or Fischer's exact test of significance was applied at 0.05 level of significance to compare the coronary angiographic finding between two groups. Diagnostic value of ST segment depression was computed keeping angiographic finding as Gold standard. There were no major differences between the two groups regarding angiographic finding. Significant coronary artery stenosis (> 50% narrowing) was found in 68 (93%) patients of group A and 23 (85%) patients of group B (p=0.18). Three vessel disease was found in 30 (41%) patients in group A and 7 (26%) patients in group B (p=0.08). Left main stem disease was found in 5 (6.8%) patients of group A and 1 (3.7%) patient of group B. Normal coronaries were found in 6% of patients among group A and 14% of patients among group B (p=0.12). Specificity, sensitivity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of ST segment depression in recovery phase was 55, 25, 85 and 6 percent respectively (95% CI; 1.16 - 2.25). In patients undergoing exercise stress test, ST segment depression occurring only in recovery phase of ETT has a diagnostic value largely comparable with that of ST segment depression induced during exercise phase of ETT. Thus careful evaluation of ST segment depression occurring only in recovery phase may add significantly to the clinical information derived from the results of ETT.

Gender differences in the value of ST-segment depression during adenosine stress testing

Previous studies have suggested that ST-segment depression with adenosine myocardial perfusion imaging (MPI) may be a marker of significant coronary artery disease (CAD). It is unclear if the significance of ST depression differs between men and women. We investigated the diagnostic accuracy of ST-segment depression with adenosine radionuclide MPI as a marker of significant CAD in men and women. Consecutive patients who had angina or suspected CAD and underwent an adenosine stress test and subsequent angiography were retrospectively analyzed. The inclusion criteria were met by 959 patients. Mean age was 64 +/- 11 years, and 43% were women. ST depression occurred in 7.6% of the cohort and more often in women (64% women vs 36% men, p <0.001). Among men and women, patients with ST-segment depression had a significantly higher peak rate-pressure product, more chest pain, and a higher ejection fraction in response to the adenosine infusion compared with those without ST-segment depression. ST-segment depression occurred more often in the presence of stenotic lesions (>/=50% and >/=70%), and left main or 3-vessel disease, regardless of gender. Transient ischemic dilation occurred more often in men with ST-segment depression. The logistic regression analysis demonstrated that the only significant predictors of left main or 3-vessel CAD were gender, an abnormal result on MPI, transient ischemic dilation, and ST-segment depression. In conclusion, ST-segment depression during adenosine MPI is an important marker of angiographically significant CAD in men and women. The presence of ST-segment depression is associated with left main disease and 3-vessel CAD.

Heart rate adjustment improves the diagnostic value of ST segment depression in subjects with diffuse SPECT perfusion defects

Background: While exercise-induced ST segment depression (STD) and the heart rate (HR) adjusted ST/HR index have each been used to assess the severity of coronary artery disease, their functional correlates with SPECT-evidenced ischemia are not well understood. Methods: We compared indices of ECG and SPECT evidenced ischemia in 129 consecutive subjects with exercise induced STD > 0.1 mV and reversible perfusion abnormalities. ECG variables included the heart rate adjusted ST/HR index (stratified according to a previously validated partition of 3.4 uV/bpm) and unadjusted STD (stratified according to a 0.2 mV partition). SPECT ischemic severity was measured on the basis of a summed stress score (SSS) calculated using a 20 segment model and a 5 point segmental score. As our prior investigations have found that the anatomic distribution of SPECT perfusion defects is a determinant of ST depression, subjects were grouped according to the presence of either single (anterior or inferior, n=68) or multiple (n=61) defects. Results: Patients stratified by STD and ST/HR partitions did not differ in mean age or peak exercise stage achieved. In the overall population, regression analysis (R = 0.36; p < 0.001) demonstrated that SSS was independently predicted by both ST depression magnitude (B = 0.28; p = 0.001) and exercise induced HR change (B = −0.22; p = 0.003). Among subjects with single SPECT defects, significant differences in mean SSS were seen with stratification by both STD (11.5 ± 4.6 vs 8.1 ± 3.7, p = 0.001) and ST/HR (11.5 ± 4.9 vs 7.7 ± 2.9, p < 0.001). Among subjects with multiple SPECT defects, stratification on the basis of STD was not associated with significant differences in mean SSS (20.1 ± 8.5 vs 17.6 ± 12.1; p = 0.4) while stratification on the basis of the ST/HR index yielded significant differences in mean SSS (ST/HR: 21.9 ± 9.6 vs 15.1 ± 9.0, p= 0.007). Conclusions: In subjects with diffuse SPECT perfusion abnormalities, HR adjustment of ST segment depression offers a more accurate reflection of ischemic severity and provides incremental diagnostic capabilities over standard ST segment depression criteria for the evaluation of myocardial ischemia.

Gender differences in the value of ST-segment depression during adenosine stress testing

Objectives: To determine the diagnostic accuracy of ST-segment depression with adenosine radionuclide myocardial perfusion imaging (MPI), as a marker of significant coronary artery disease (CAD) in men and women. Background: Previous studies have suggested that ST-segment depression with adenosine MPI may be a marker of significant CAD. It is unclear if the significance of ST depression differs between men and women. Methods: Consecutive patients with angina or suspected CAD who underwent an adenosine stress test and subsequent angiography were retrospectively analyzed. Results: A total of 959 patients were included in this study. The mean age was 64 ±11 years, 43% of whom were women. ST depression occurred in 7.6% of the cohort and occurred more often in women (64% women vs. 36%, P<0.001). In both genders, those patients with ST-segment depression had a significantly higher peak rate-pressure product, more chest pain, and a higher ejection fraction in response to the adenosine infusion, compared to those without ST-segment depression. ST-segment depression occurred more often in the presence of stenotic lesions (both ≥50% and ≥70%) and left main or three-vessel disease, regardless of gender. Transient ischemic dilation (TID) occurred more often in men with ST-segment depression. A stepwise logistic regression analysis demonstrated that the only significant predictors of left main or three-vessel CAD were gender, the presence of an abnormal MPI, the presence of TID, and ST-segment depression. Conclusion: ST-segment depression during adenosine MPI is an important marker of angiographically significant CAD in both men and women. The presence of ST-segment depression is associated with left main disease and three-vessel CAD.

Comparison of positron emission tomography with the resting electrocardiogram for assessing viable myocardium in chronic ischemic cardiomyopathy involving the anterior left ventricular wall

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Prognostic value of ST segment depression in acute coronary syndromes: insights from PARAGON-A applied to GUSTO-IIb

Abstract OBJECTIVES Our objectives were to develop a risk-stratification model addressing the importance of the magnitude and distribution of ST segment depression in predicting long-term outcomes and to validate the model in an analogous patient population. BACKGROUND Although patients without ST segment elevation presenting with acute coronary syndromes represent an increasingly frequent population admitted to coronary care units, little attention has been paid to quantifying their ST segment abnormalities. METHODS ST segment depression was categorized into three groups: 1) no ST segment depression; 2) 1-mm ST segment depression in two contiguous leads; and 3) ST segment depression ≥2 mm in two contiguous leads. A logistic regression model was developed using Platelet IIb/IIIa Antagonism for the Reduction of Acute coronary syndrome events in a Global Organization Network (PARAGON-A) data to assess the prognostic value of the extent and distribution of ST segment depression in predicting one-year mortality. The model was validated using the non-ST segment elevation population in Global Use of Strategies To Open occluded arteries in acute coronary syndromes (GUSTO-IIb). RESULTS ST segment depression was the strongest predictor of one-year mortality, accounting for 35% of the model’s predictive power. Patients with ST segment depression ≥2 mm were ∼6 times (odds ratio [OR] 5.73, 95% confidence interval [CI] 2.8 to 11.6) more likely to die within one year than patients with no ST segment depression. On validation, the model showed good discriminatory power (c-index = 0.75). Patients with ST segment depression ≥2 mm in more than one region were almost 10 times more likely to die within one year than patients with no ST segment depression. CONCLUSIONS These data provide new evidence supporting the powerful prognostic value of the baseline electrocardiogram and, in particular, the magnitude and distribution of ST segment depression in predicting unfavorable events.

Prognostic value of ST segment depression in acute coronary syndromes: insights from PARAGON-A applied to GUSTO-IIb

OBJECTIVESOur objectives were to develop a risk-stratification model addressing the importance of the magnitude and distribution of ST segment depression in predicting long-term outcomes and to validate the model in an analogous patient population.BACKGROUNDAlthough patients without ST segment elevation presenting with acute coronary syndromes represent an increasingly frequent population admitted to coronary care units, little attention has been paid to quantifying their ST segment abnormalities.METHODSST segment depression was categorized into three groups: 1) no ST segment depression; 2) 1-mm ST segment depression in two contiguous leads; and 3) ST segment depression ≥2 mm in two contiguous leads. A logistic regression model was developed using Platelet IIb/IIIa Antagonism for the Reduction of Acute coronary syndrome events in a Global Organization Network (PARAGON-A) data to assess the prognostic value of the extent and distribution of ST segment depression in predicting one-year mortality. The model was validated using the non-ST segment elevation population in Global Use of Strategies To Open occluded arteries in acute coronary syndromes (GUSTO-IIb).RESULTSST segment depression was the strongest predictor of one-year mortality, accounting for 35% of the model’s predictive power. Patients with ST segment depression ≥2 mm were ∼6 times (odds ratio [OR] 5.73, 95% confidence interval [CI] 2.8 to 11.6) more likely to die within one year than patients with no ST segment depression. On validation, the model showed good discriminatory power (c-index = 0.75). Patients with ST segment depression ≥2 mm in more than one region were almost 10 times more likely to die within one year than patients with no ST segment depression.CONCLUSIONSThese data provide new evidence supporting the powerful prognostic value of the baseline electrocardiogram and, in particular, the magnitude and distribution of ST segment depression in predicting unfavorable events.

ECG Variable Cine: computer program for presentation of temporal changes in ECG variables over different number of ECG leads

The analysis of exercise electrocardiogram (ECG) is based on the alteration of the measured variables in the detection of coronary artery disease (CAD). In its existing form the analysis of the exercise ECG is laborious and requires much time. The temporal analysis of the ECG variable and the comparison between different phases of the exercise test is difficult and time consuming, especially the simultaneous examination of the variables over several leads. In this article we present a computer program, ECG Variable Cine, for the visualization of the temporal changes of values of exercise ECG variables over the selected ECG lead system. The program includes the stationary 3-D presentation for the variables' alteration simultaneously in all selected leads over the time of exercise test. In addition, the program determines two parameters; the average value of the variable over the selected leads at every sample moment, and the chronotropic index, a parameter that indicates heart rate response to exercise. According to the results the average value of ST-segment deviation at the end of the exercise over the leads and chronotropic index are clinically more competent than the maximum value of ST-segment depression in the detection of CAD.

Value of ST-segment depression during paroxysmal supraventricular tachycardia in the diagnosis of coronary artery disease

We evaluated 39 patients >45 years old with paroxysmal supraventricular tachycardia (SVT), 21 of whom had ST-segment depression during SVT. Treadmill exercise testing, including thallium stress scintigraphy, was performed in all patients and coronary angiography in 21 patients with ST-segment depression. Based on the presence of abnormal findings on exercise electrocardiogram and/or thallium in 7 of 21 patients (33%) with ST-segment depression, with additional corroboration by angiographic data, we conclude that myocardial ischemia and coronary artery disease is one, but not the only, mechanism involved in the genesis of ST-segment depression during paroxysmal SVT.

Long-term prognostic significance of ST segment depression during acute myocardial infraction

Objectives. The purpose of this study was to evaluate the long-term prognostic value of ST segment depression on the electrocardiogram (ECG) in patients with acute myocardial infarction.Background. The prognostic importance of ST depression on the ECG has been studied in small groups of patients with infarction, but larger numbers are needed.Methods. Coronary care unit ECGs of 1,234 patients who survived the coronary care unit with acute Q wave (n = 896) or non-Q wave (n = 338) myocardial infarction were analyzed for the presence of ST segment depression. Patients were followed up for up to 4 years.Results. ST segment depression was present in 607 patients. Those with ST segment depression had a 1-year mortality rate of 10.3% compared with a rate of 5.6% for those without ST segment depression (p = 0.002). This effect was seen in both the Q wave and non-Q wave subgroups, of the 437 patients with anterior ST segment elevation, those with ST segment depression in other regions had a 13,6% 1-year mortality rate compared with a rate of 6.9% for those with no ST segment depression (p = 0.0005). Of the 514 patients with inferior ST segment elevation, those with ST segment depression in other leads had an 11.0% 1-year mortality rate compared with a 1.8% rate for those with no ST segment depression (p = 0.0001). The Cox proportional hazards model showed that ST segment depression was an independent predictor of mortality over the follow-up period.Conclusions. ST segment depression on the admitting ECG in patients with acute myocardial infarction is a predictor of increased mortality in the year after infarction.

Discriminant value of ST-segment depression in computerized exercise stress test with different degrees of coronary artery stenosis

Discriminant value of ST-segment depression in computerized exercise stress test with different degrees of coronary artery stenosis