Significance of S-T segment elevations in acute myocardial ischemia

Hashimoto, Keiichi; Corday, Eliot; Lang, Tzu-Wang; Rubins, Steven; Meerbaum, Samuel; Osher, Jules; Farcot, Jean-Christian; Davidson, Robert M.

doi:10.1016/0002-9149(76)90387-8

Cited by 25 publications

(12 citation statements)

References 23 publications

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“…Similarly, reperfusion after a 1-h coronary occlusion in dogs produced a significant reduction in epicardial ST-segment elevation with either no change or actual decrease in zonal contraction as measured by Walton-Brodie strain gauges sutured over the territory of the occluded artery (33). With solid angle analysis (34) (36).…”

Section: Discussionmentioning

confidence: 99%

Relationship between epicardial ST-segment elevation and myocardial ischemic damage after experimental coronary artery occlusion in dogs.

Heng¹,

Singh²,

Norris³

et al. 1976

J. Clin. Invest.

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A B S T R A C T The relationship between early and late epicardial electrocardiographic changes as well as those in regional myocardial blood flow (MBF) and the severity of myocardial damage was determined in 12 anesthetized dogs with left anterior descending coronary artery ligation. Radioactive microspheres (15 ,um) were used to measure regional MBF at 15 min (early) and 24h (late) after coronary occlusion. Severity of myocardial damage was assessed by the extent of myocardial creatine phosphokinase depletion 24 h after coronary ligation. There was a close linear correlation between myocardial creatine phosphokinase activity and regional MBF both early (r = 0.93, 2P < 0.001) and late (r = 0.88, 2P < 0.001). An inverse but less precise relationship existed between acute epicardial ST-segment elevation and early (r = -0.41, 2P < 0.001), or late (r = -0.35, 2P < 0.05) regional MBF. Similarly, a weak correlation was found between myocardial creatine phosphokinase (IU/mg protein) at 24 h and early epicardial ST (millivolt) elevation (r = -0.36, 2P < 0.02). In the center zones of the infarct with MBF 1/10 of normal, about 35% of the areas with normal QRS width had no epicardial ST-segment elevation 15 min after coronary occlusion. About 44% of the areas which An abstract embodying the results was presented at the 48th Annual Scientific Meeting of the American Heart Association, Anaheim, Calif., November 1975 and has been published as an abstract in Circulation. 51, 52: II-6, (1975 developed pathological Q-waves in the electrocardiogram at 24 h had no ST elevation 15 min after coronary ligation. Late evolution of abnormal Qwaves occurred almost invariably in areas in which the early MBF was reduced to less than 50% of normal and in areas which subsequently had myocardial creatine phosphokinase levels reduced to less than 60%o of normal. After coronary occlusion, the severity of the ultimate myocardial damage, which was directly proportional to the degree of reduction in MBF, was therefore not reliably predicted by the early epicardial ST-segment elevation. The data obtained in these studies suggest the need for caution in the use of acute ST-segment elevation as a predictive index of the extent or severity of myocardial ischemic damage.

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Section: Discussionmentioning

confidence: 99%

Relationship between epicardial ST-segment elevation and myocardial ischemic damage after experimental coronary artery occlusion in dogs.

Heng¹,

Singh²,

Norris³

et al. 1976

J. Clin. Invest.

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“…Two studies showed that the IC‐ECG does not perform as well as S‐ECG in the RCA territory 4, 5 compared to left circumflex or left anterior descending coronary territories. An unexplored consideration in clinical studies is the effect of the distance between the angioplasty guidewire tip and the angioplasty balloon 1 on the detection of localized ischemia. Some studies have maintained the wire tip very close to the balloon, 6 however this is not always specified and does not represent routine interventional practice, where the angioplasty wire is usually secured some distance distal to the point of balloon inflation.…”

Section: Comparing Surface and Intracoronary Electrocardiogrammentioning

confidence: 99%

“…Continuous measurement of the IC‐ECG may be important, as the sampling intervals for intermittent recordings of the IC‐ECG are not standardized, and arbitrary time points may have contributed to the apparent absence of ischemia on the IC‐ECG in some studies 8–10 . Indeed, original animal studies highlighted the spontaneous variation in ST‐segment elevation over time 1 . Continuous monitoring of the IC‐ECG should be encouraged in future studies as this will allow both the standardization of time points and thresholds for ST‐segment deviation with which to define clinically relevant ischemia.…”

Section: Acquiring the Intracoronary Electrocardiogrammentioning

confidence: 99%

“…The intracoronary electrocardiogram (IC‐ECG) was first described in animals by Hashimoto et al in 1974 1 . Meier et al, however, were the first to report recording the IC‐ECG using an angioplasty guidewire connected to an electrocardiogram in humans 2 .…”

Section: Introductionmentioning

confidence: 99%

“…The intracoronary electrocardiogram (IC-ECG) was first described in animals by Hashimoto et al in 1974. 1 Meier et al, however, were the first to report recording the IC-ECG using an angioplasty guidewire connected to an electrocardiogram in humans. 2 Since then, research using the IC-ECG has had particular relevance to studies during coronary angioplasty given the ease of measuring the IC-ECG in this setting.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Intracoronary Electrocardiogram in Percutaneous Coronary Intervention

Yong¹,

Lowe²,

Ng³

et al. 2009

J Interven Cardiology

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The technique of obtaining an epicardial electrocardiogram trace by connecting the guidewire during coronary angioplasty to an electrocardiogram lead has been used since 1985. The intracoronary electrocardiogram appears to be more sensitive than the surface electrocardiogram in detecting transient ischemia, particularly in the territory of the left anterior descending and left circumflex coronary arteries. Importantly, recent studies have shown the intracoronary electrocardiogram to be particularly useful in demonstrating pre- and postconditioning during interventional procedures, predicting periprocedural myocardial damage, and in the determination of regional viability in the catheterization laboratory. Barriers to the use of the intracoronary electrocardiogram in the clinical setting include the lack of standardized methods for acquiring and analyzing the intracoronary electrocardiogram, and the lack of commercially available continuous intracoronary monitoring systems to permit analysis while performing coronary interventions. Facilitating these relatively simple technical developments may permit optimal integration of the intracoronary electrocardiogram into the catheterization laboratory.

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Optimal ECG monitoring during percutaneous transluminal coronary angioplasty of the left anterior descending artery

Feldman

Childers

Chua

1987

Cathet. Cardiovasc. Diagn.

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During percutaneous transluminal coronary angioplasty (PTCA) frontal ECG leads are routinely monitored. The detection of ST segment deviation during the procedure is important for decisions regarding guiding catheter seating and the timing of balloon inflation and deflation. ST segment deviation appears on intracoronary electrograms in the absence of changes on the surface ECG in many patients, while the reverse is true in some individuals. When a precordial lead is employed, V5 or V6 is most commonly selected. The surface ECG leads most sensitive for monitoring ischemia during left anterior descending angioplasty are not known. In nine lead surface ECGs recorded during balloon inflation, a small degree of ST segment elevation occurred in leads I, aVL, and V5. Lead V2 demonstrated an increase in ST displacement from 0.0 +/- 0.03 mV to 0.29 +/- 0.25 mV during coronary occlusion (p less than 0.01). We conclude that if V5 or V6 is used as a single precordial lead, surface ECG alterations are easily overlooked. During left anterior descending occlusion the most sensitive surface lead is V2. Optimal ECG monitoring during PTCA in some cases should involve surface lead V2 or the intracoronary lead.

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Significance of S-T segment elevations in acute myocardial ischemia

Cited by 25 publications

References 23 publications

Relationship between epicardial ST-segment elevation and myocardial ischemic damage after experimental coronary artery occlusion in dogs.

Relationship between epicardial ST-segment elevation and myocardial ischemic damage after experimental coronary artery occlusion in dogs.

The Intracoronary Electrocardiogram in Percutaneous Coronary Intervention

Optimal ECG monitoring during percutaneous transluminal coronary angioplasty of the left anterior descending artery

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