Publication: ST yükselmeli miyokart enfarktüsü tanısında horizontal elektrokardiyografi yönteminin standart elektrokardiyografi yöntemi ile karşılaştırılması
Abstract
Kolay bulunabilir, tekrar edilebilir ve ucuz bir tetkik olan standart 12 derivasyonlu elektrokardiyografinin (SEKG) akut koroner sendrom (AKS) tanısında duyarlılığı bazı vakalarda düşük kalabilmektedir. Bu çalışmada anterior ya da lateral STYME tanısı konan hastalarda V3–6 derivasyonlarının 4. interkostal aralıktan horizontal düzlemde kaydedilmesinin elektrokardiyografik olarak ST segment değişimini belirlemedeki üstünlüğü araştırıldı. Çalışmaya anterior ve lateral STYME tanısı konan 58 hasta dahil edildi. Hastalarda acil servis başvuruları sırasında eşzamanlı horizontal elektrokardiyografi (HEKG) ve SEKG kayıtları alındı. HEKG ve SEKG örnekleri karşılaştırıldığında HEKG’de ortalama ST segment değişim miktarlarına (mm) göre, V3 derivasyonunda anlamlı istatistiksel fark izlenmezken, V4 (2,7±2 vs 2,1±2,1 p=0,001), V5 (2,1±1,7 vs 1,2±1,6 p<0,001), V6 (0,9±1 vs 0,4±1,2 p<0,001) derivasyonlarında ortalama ST segment miktarlarında anlamlı olarak artış izlendi. Erkek hastalarda HEKG ve SEKG kayıtları değerlendirildiğinde, HEKG’de V4 (3,0±2,1 vs 2,2±2,2 p<0,001), V5 (2,2±1,8 vs 1,4±1,7 p<0,001), V6 (1,0±1,0 vs 0,4±1,3 p<0,001) derivasyonlarında ST segment değişim miktarlarında (mm) anlamlı artış saptandı. VKİ>30kg/ m2 olan hastalarda HEKG’de SEKG’ye göre ortalama ST segment değişim miktarında istatistiksel olarak anlamlı fark yokken, VKi<30kg/ m2 olan hastalarda V4 (2,9±2,1 vs 2,1±2,4 p=0,004), V5 (2,2±1,9 vs 1,3±1,7 p<0,001), V6 (1,1±1,1 vs 0,4±1,1 p<0,001) istatistiksel olarak anlamlı artış saptanmıştır. Sonuç olarak, HEKG yöntemi, SEKG yöntemine kıyasla akut anterior ve lateral STYME hastalarında, ortalama ST segment değişim miktarını ortaya koymada anlamlı olarak daha üstün bulunmuştur. HEKG yönteminin günlük pratikte kolay uygulanması ve SEKG’ye göre belirgin tanısal üstünlüğü nedeniyle akut göğüs ağrısına yaklaşımda ilk tercih olarak kullanılması önerilir. ANAHTAR SÖZCÜKLER: ST yükselmeli miyokart enfarktüsü, horizontal elektrokardiyografi, ST segment, akut koroner sendrom, göğüs ağrısı, duyarlılık
Standart 12-lead electrocardiogram (SECG) is an easily applied technique for diagnosing acute coronary syndrome (ACS). However, the sensitivity of SECG is generally believed to be suboptimal for diagnosing ACS. The aim of the present study is to test the diagnostic superiority of horizontal electrocardiography (HECG) by placing the leads (V3-6 ) horizontally on the 4th intercostal space compared to SECG in diagnosing anterior or lateral ST segment elevation myocardial infarction (STEMI). Patients (n=58) who were diagnosed with acute anterior or lateral STEMI were included in the study. Simultaneous HECG and SECG recordings were obtained and compared with each other. The mean ST segment change (mm) on HECG was significantly higher than SECG in V4 (2.7±2 vs 2.1±2.1 p=0.001), V5 (2.1±1.7 vs 1.2±1.6 p<0.001) and V6 (0.9±1 vs 0.4±1.2 p<0.001), respectively. When HECG and SECG recordings were compared in men, mean ST segment change (mm) on HECG were significantly higher than SECG in V4 (3.0±2.1 vs 2.2±2.2 p<0.001), V5 (2.2±1.8 vs 1.4±1,7 p<0.001) and V6 (1.0±1.0 vs 0.4±1.3 p<0.001), respectively. In patients with body mass index (BMİ)>30kg/ m2 there was no statistically significant difference in mean ST segment change between both HECG and SECG technique. When HECG and SECG recordings were compared in patients with BMİ<30kg/ m2, mean ST segment change (mm) on HECG was significantly higher than SECG in V4 (2.9±2.1 vs 2.1±2.4 p=0.004), V5 (2.2±1.9 vs 1.3±1.7 p<0.001) and V6 (1.1±1.1 vs 0.4±1.1 p<0.001), respectively. In conclusion, mean ST segment change in patients with anterior and lateral STEMİ is significantly higher in HECG rather than SECG technique. Therefore HECG technique may be recommended for increasing diagnostic sensitivity of acute anterior and lateral STEMI in emergency settings. KEY WORDS: ST elevation myocardial infarction, horizontal ECG, acute coronary syndrome, chest pain, diagnosis, sensitivity
Standart 12-lead electrocardiogram (SECG) is an easily applied technique for diagnosing acute coronary syndrome (ACS). However, the sensitivity of SECG is generally believed to be suboptimal for diagnosing ACS. The aim of the present study is to test the diagnostic superiority of horizontal electrocardiography (HECG) by placing the leads (V3-6 ) horizontally on the 4th intercostal space compared to SECG in diagnosing anterior or lateral ST segment elevation myocardial infarction (STEMI). Patients (n=58) who were diagnosed with acute anterior or lateral STEMI were included in the study. Simultaneous HECG and SECG recordings were obtained and compared with each other. The mean ST segment change (mm) on HECG was significantly higher than SECG in V4 (2.7±2 vs 2.1±2.1 p=0.001), V5 (2.1±1.7 vs 1.2±1.6 p<0.001) and V6 (0.9±1 vs 0.4±1.2 p<0.001), respectively. When HECG and SECG recordings were compared in men, mean ST segment change (mm) on HECG were significantly higher than SECG in V4 (3.0±2.1 vs 2.2±2.2 p<0.001), V5 (2.2±1.8 vs 1.4±1,7 p<0.001) and V6 (1.0±1.0 vs 0.4±1.3 p<0.001), respectively. In patients with body mass index (BMİ)>30kg/ m2 there was no statistically significant difference in mean ST segment change between both HECG and SECG technique. When HECG and SECG recordings were compared in patients with BMİ<30kg/ m2, mean ST segment change (mm) on HECG was significantly higher than SECG in V4 (2.9±2.1 vs 2.1±2.4 p=0.004), V5 (2.2±1.9 vs 1.3±1.7 p<0.001) and V6 (1.1±1.1 vs 0.4±1.1 p<0.001), respectively. In conclusion, mean ST segment change in patients with anterior and lateral STEMİ is significantly higher in HECG rather than SECG technique. Therefore HECG technique may be recommended for increasing diagnostic sensitivity of acute anterior and lateral STEMI in emergency settings. KEY WORDS: ST elevation myocardial infarction, horizontal ECG, acute coronary syndrome, chest pain, diagnosis, sensitivity