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Electrocardiographic predictors of proximal left anterior descending coronary artery occlusion

100%
Kojuri J., Vosoughi A., Khosropanah S., Aslani A.
Open Medicine
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2008
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vol. 3
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issue 3
294-299
EN
Proximal occlusion of the left anterior descending coronary artery (LAD) results in a less favorable prognosis in coronary angiography. Therefore, it is important to determine whether there are significant lesions in LAD by electrocardiography (ECG) before coronary angiography. Twelve-lead ECG was compared in 130 patients with significant lesions (≥70% stenosis) confined to proximal part of the LAD (P LAD group) and 492 patients with normal coronary angiography (control group). Fifty-nine patients in the P LAD group and 18 patients in the control group had signs of anterior myocardial infarction as shown by ST elevation (≥1.0 mV) in two consecutive pericardial leads or the presence of a pathological Q wave. An inverted U wave (biphasic T wave) in leads V1 to V4 had a sensitivity of 49.3% (35/71) in P LAD patients without signs of anterior myocardial infarction (MI) and 96.6 % (57/59; specificity, 66.6%; positive predictive value, 90.9 %) in the P LAD patients with signs of anterior MI. In the P LAD patients with signs of anterior MI, T inversion in V4–V5 had a lower sensitivity (67.0% [40/59]) than an inverted U wave. ST depression in inferior leads and ST depression in V5 were not useful markers of proximal LAD occlusion. In conclusions, an inverted U wave in V1 to V4 (or in each of these leads) and T inversion in V4–V5 are the best predictors of significant proximal LAD lesion, especially in patients with ECG findings of anterior MI.
2
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Erratum to: SAECG in exercise test for prediction of diabetic coronary artery disease

100%
Bigi M., Aslani A., Aslani A.
Open Medicine
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2010
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vol. 5
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issue 5
649-649
3
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SAECG in exercise test for prediction of diabetic coronary artery disease

100%
Bigi M., Aslani A., Aslani A.
Open Medicine
|
2010
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vol. 5
|
issue 3
298-302
EN
Signal averaged electrocardiogram (SAECG) is considered an important noninvasive indicator identifying patients at risk for ventricular arrhythmias. The aim of this study was to improve noninvasive prediction of CAD by integrating SAECG with the result of exercise tests in diabetic patients. Diabetic patients with stable angina pectoris underwent exercise testing and SAECG. Then a diagnostic score was derived that combined results of exercise testing and SAECG. A diagnostic score (0 to 2 points) was calculated by assigning 1 point for a positive exercise test result and 1 point for a positive SAECG. One hundred and seventy patients were included in the study. In patients with a score of 0, the likelihood of CAD is 18% whereas the likelihood of CAD is 95% in patients with a score of 2. Triple vessel CAD is present in 54%, 7% and only 1.5% of patients with score 2, 1 and 0 respectively. Therefore, patients with score 2 have a poor prognosis compared with score 1 or 0. A diagnostic score combining exercise testing and SAECG can distinguish patients with CAD from those without CAD with high accuracy in diabetic patients.
4
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Effect of electrical cardioversion on stented coronary artery

76%
Sharifkazemi M., Safai A., Aslani A., Dehghan S., Rezakhani A., Rezaian G.
Open Medicine
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2010
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vol. 5
|
issue 3
303-307
EN
Direct current cardioversion, which produces electrical energy, is highly effective for the termination of cardiac arrhythmia and sometimes is indicated in patients with coronary artery stents due to arrhythmias. Only a few reports have been published describing the potential adverse interactions between foreign bodies and electrical cardioversion. The aim of this animal study was to investigate the acute effect of repeated external defibrillation on coronary artery tissue and adjacent myocardium at the implantation site of coronary stents. Custom-made stainless steel stents were implanted in the coronary arteries of 7 dogs. Rapid ventricular pacing was performed to induce ventricular fibrillation. Defibrillation was achieved [5 J/kg; n=2 and 8 J/kg; n=3]. In 2 animals, coronary stent was implanted but defibrillation was not performed [control group]. The animal’s heart were excised and sent for microscopic examination. The light and electron micrographs of heart muscles showed no histological and ultrastructural changes in defibrillated and control dogs. It is concluded that nickel coating provides good resistance to heat in coronary stents and repeated defibrillation does not cause histopathological changes typical of thermal injury at the implantation site of coronary stent.
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