Implications of Using the Cabrera Sequence for Diagnosing Acute Coronary Syndrome

Kosuge, Masami; Kimura, Kazuo

doi:10.1253/circj.cj-16-0126

Cited by 8 publications

(11 citation statements)

References 44 publications

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“…Because the right inferior myocardium is mainly supplied by RCA blood, when the RCA is occluded, the spatial vector of the ST-segment will be directed, resulting in greater STE in lead III than in lead II. [ 35 ] STE in III > II and STD in aVL > I performed best in specificity, but it was not conclusive enough for the small number of studies (n = 4). Previous study reported ST depression occurred more frequently in aVL than in any other lead, so despite poor specificity of STD in aVL (0.41), it was still valuable due to a sensitive early electrocardiographic sign of acute WIMI.…”

Section: Discussionmentioning

confidence: 86%

Electrocardiogram criteria of limb leads predicting right coronary artery as culprit artery in inferior wall myocardial infarction

Liang

Wu²,

et al. 2018

Medicine

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Background:Prior studies have proposed several electrocardiogram (ECG) criteria in limb leads for identifying the culprit coronary artery (CCA) in patients with acute inferior wall myocardial infarction (IWMI). The aim of our study was to conduct an evidence-based evaluation and test accuracy comparison of these criteria.Methods:We searched the PubMed, Embase, and Ovid. Eligible studies to assess the diagnostic performance of ECG criteria predicting CCA in IWMI were reviewed for inclusion. A diagnostic meta-analysis of bivariate approach was performed for pooled estimates of sensitivity and specificity, and meta-regression was implemented to investigate sources of heterogeneity.Results:Twenty-four studies with 4431 unique participants met the inclusion criteria. The pooled sensitivity and specificity for ST-segment elevation (STE) in III > II, ST-segment depression (STD) in I, STD in aVL, STD in aVL > I, STE in III > II, and STD in aVL > I were 0.91 (0.88–0.94) and 0.69 (0.53–0.81), 0.80 (0.73–0.87) and 0.69 (0.62–0.76), 0.90 (0.81–0.95) and 0.41 (0.22–0.62), 0.84 (0.75–0.91) and 0.72 (0.48–0.88), and 0.79 (0.62–0.90) and 1.00 (0.37–1.00), respectively. Heterogeneity investigation showed that whether multi-vessel diseased patients were excluded, sample size, publication year, etc., could influence the diagnostic performance.Conclusion:STE in III > II performed better than other criteria for predicting RCA as CCA in IWMI, and STE in III > II and STD in aVL > I were potential and simple algorithms. ECG could be an effective tool to identify the CCA, but future studies are clearly needed to address the potential of diagnostic and prognostic value.

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Section: Discussionmentioning

confidence: 86%

Electrocardiogram criteria of limb leads predicting right coronary artery as culprit artery in inferior wall myocardial infarction

Liang

Wu²,

et al. 2018

Medicine

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“…ECG from a patient with proximal LAD occlusion. ST elevation in anterior leads in combination with ST elevation in aVR in the standard presentation ( a ) is a sign of proximal LAD occlusion [16, 37]. In the Cabrera sequence ( b ), ST elevation in aVR is displayed as ST depression in −aVR, which makes it easy to appreciate the ST -segment progression.…”

Section: Main Textmentioning

confidence: 99%

“…The use of aVR is considered to be important in the differential diagnosis between STEMI and takotsubo cardiomyopathy [36, 37]. Although ST elevation can be absent on admission ECGs in many cases of takotsubo cardiomyopathy, both the characteristics of the ST elevation, when present, and its time course are similar to those in acute myocardial infarction [36].…”

Section: Main Textmentioning

confidence: 99%

Why complicate an important task? An orderly display of the limb leads in the 12-lead electrocardiogram and its implications for recognition of acute coronary syndrome

Lindow

Birnbaum

Nikus

et al. 2019

BMC Cardiovasc Disord

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BackgroundIn the standard ECG display, limb leads are presented in a non-anatomical sequence: I, II, III, aVR, aVL, aVF. The Cabrera system is a display format which instead presents the limb leads in a cranial/left-to-caudal/right sequence, i.e. in an anatomically sequential order. Lead aVR is replaced in the Cabrera display by its inverted version, −aVR, which is presented in its logical place between lead I and lead II.Main textIn this debate article possible implications of using the Cabrera display, instead of the standard, non-contiguous lead display, are presented, focusing on its use in patients with possible acute coronary syndrome. The importance of appreciating reciprocal limb-lead ECG changes and the diagnostic and prognostic value of including aVR or lead −aVR in ECG interpretation in acute coronary syndrome is covered. Illustrative cases and ECGs are presented with both the standard and contiguous limb lead display for each ECG.A contiguous lead display is useful when diagnosing acute coronary syndrome in at least 3 ways: 1) when contiguous leads are present adjacent to each other, identification of ST elevation in two contiguous leads is simple; 2) a contiguous lead display facilitates understanding of lead relationships as well as reciprocal changes; 3) it makes the common neglect of lead aVR unlikely.ConlusionsIt is logical to display the limb leads in their sequential anatomical order and it may have advantages both in diagnostics and ECG learning.

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“…Acute coronary syndrome (ACS) is a medical emergency ( Kosuge and Kimura, 2016 ). The underlying mechanism of ACS is triggered by atheromatous plaque enlargement, instability, and rupture or erosion ( Amsterdam et al, 2014 ; Saremi, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Comparative Efficacy of Danshen Class Injections for Treating Acute Coronary Syndrome: A Multidimensional Bayesian Network Meta-Analysis of Randomized Controlled Trials

Guo

et al. 2020

Front. Pharmacol.

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Background Acute coronary syndrome, that is a common and serious cardiovascular disease, imposes a huge economic burden on global public health. And Danshen class injections are commonly used in the treatment of acute coronary syndrome in China. Thus, the Bayesian network meta-analysis was devised to investigate the efficacy of different Danshen class injections against acute coronary syndrome. Methods Eligible inclusion and exclusion criteria were established in advance. Then, a systematic literature search was performed in several databases from inception to February 2020. Further, the included randomized controlled trials data were adopted to calculation, prepare graphs and multidimensional cluster analysis by WinBUGS 1.4.3, Stata V.13.0 and R 3.6.1 software, respectively. Results A total of 53 eligible randomized controlled trial studies with 6401 patients were obtained that evaluated the clinical effectiveness rate, the level of hypersensitive C-reactive protein, C-reactive protein, interleukin-6, fibrinogen, and adverse reactions after the application of Danshen class injections plus western medicine. Compared with western medicine alone, Danshen class injections combined with western medicine therapy were associated with significantly improved the therapeutic effect. In addition, the results of the multidimensional cluster analysis demonstrated that Danhong injection + western medicine and Danshen injection + western medicine had better therapeutic effects. However, since most eligible randomized controlled trial studies did not focus on the monitoring of adverse reactions, the safety of these Chinese herbal injections needs to be further explored. Conclusion Based on this Bayesian network meta-analysis results, Danhong injection + western medicine and Danshen injection + western medicine might have a better impact on acute coronary syndrome patients. Nevertheless, more large samples, high-quality clinical and multicenter randomized controlled trial studies should be tested and verified in the future.

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Implications of Using the Cabrera Sequence for Diagnosing Acute Coronary Syndrome

Cited by 8 publications

References 44 publications

Electrocardiogram criteria of limb leads predicting right coronary artery as culprit artery in inferior wall myocardial infarction

Electrocardiogram criteria of limb leads predicting right coronary artery as culprit artery in inferior wall myocardial infarction

Why complicate an important task? An orderly display of the limb leads in the 12-lead electrocardiogram and its implications for recognition of acute coronary syndrome

Comparative Efficacy of Danshen Class Injections for Treating Acute Coronary Syndrome: A Multidimensional Bayesian Network Meta-Analysis of Randomized Controlled Trials

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