Clinical Significance of Upsloping ST Depression on Resting Electrocardiogram

Khalid, Umair; Birnbaum, Yochai

doi:10.1111/anec.12273

Cited by 1 publication

(3 citation statements)

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“…Of note, upsloping STD is not a specific marker of ischemia as it is often associated with increased heart rate (Desai, Crugnale, Mondeau, Helin, & Mannting, 2002; Polizos & Ellestad, 2006) and can even be found in myocarditis (García‐Izquierdo et al., 2018) and post‐supraventricular tachycardia (Khalid & Birnbaum, 2016). Upsloping STD in patients with chest pain without tachycardia, with concomitant tall symmetrical T waves and even pathological Q wave or equivalent is the typical feature for patients with ongoing ischemia, while upsloping STD with tachycardia in asymptomatic or atypical cases is the characteristic for patients, where the background factor is other than ischemia (Alam, Nikus, Fiol, Bayes de Luna, & Birnbaum, 2019; Khalid & Birnbaum, 2016).…”

Section: Discussionmentioning

confidence: 99%

Section: Possible Background Mechanism For the De Winter Patternmentioning

confidence: 99%

“…Upsloping STD in patients with chest pain without tachycardia, with concomitant tall symmetrical T waves and even pathological Q wave or equivalent is the typical feature for patients with ongoing ischemia, while upsloping STD with tachycardia in asymptomatic or atypical cases is the characteristic for patients, where the background factor is other than ischemia (Alam, Nikus, Fiol, Bayes de Luna, & Birnbaum, 2019;Khalid & Birnbaum, 2016).…”

Section: Possible Background Mechanism For the De Winter Patternmentioning

confidence: 99%

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The de Winter ECG pattern: Distribution and morphology of ST depression

Zhong-qun

Han

et al. 2020

Noninvasive Electrocardiol

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Background The reported positive predictive value (PPV) for the “de Winter ECG pattern” to predict an acute left anterior descending artery (LAD) lesion is inconsistent. Besides, the morphology of upsloping or nonupsloping ST depression (STD) may have different significance of severity and prognostication. Methods We searched the MEDLINE database using “de Winter” or “junctional ST‐depression with tall symmetrical T‐waves” or “tall T wave” or “STEMI equivalent” as the item up to March 2020. We compared the ECG differences between the different culprit arteries and various morphological STD. Results A total of 70 patients with analyzable ECGs were included. In 60 patients (LAD group), the LAD was the culprit artery, while in 10 patients (non‐LAD group), there were other etiologies. Maximal STD in V2 or V3 had a PPV of 89% of all patients and 98% of patients without ST elevation in V2 to detect an acute LAD lesion. The presence of q/Q‐wave or poor R‐wave progression in the precordial leads was significantly more often found in patients with upsloping STD than in patients with nonupsloping STD in the LAD group (84% vs. 27%, p < .01). In 18 patients, the ECG showed a change from upsloping to nonupsloping STD from the leads with maximal STD to the surrounding leads with less STD. Conclusions The location of the maximal STD in the precordial leads differs between patients with LAD as the culprit artery and other etiologies of the de Winter ECG pattern. Upsloping STD signifies more severe signs of ischemia than nonupsloping STD.

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