Circulation, Vol 52, 16-27, Copyright © 1975 by American Heart Association
JE Muller, PR Maroko and E Braunwald
Precordial electrocardiographic mapping has been proposed as a method for
evaluating the extent of myocardial injury in patients with acute
myocardial infarction. To assess the relationship between direct measures
of myocardial cell damage and findings obtained by precordial mapping, the
left anterior descending coronary artery (LAD) was occluded in dogs
instrumented for simultaneous recording of epicardial and precordial
electrocardiograms. The sum in millivolts of ST-segment elevation recorded
from 30 electrodes placed in a Silastic grid sutured to the epicardium
(EPIsigmaST) was compared to that recorded from 30 precordial electrodes
(PresigmaST). While ischemic injury was: 1) maintained constant with a
fixed occlusion; 2) reduced by partial reperfusion; 3) increased by
addition of a second occlusion; or 4) increased repeatedly by intermittent
infusions of isoproterenol, EPIsigmaST and PresigmaST were always closely
correlated in each of the 16 dogs studied: r equal 0.92 plus or minus 0.01
(SEM). In seven control dogs, 30 minutes after coronary occlusion,
PresigmaST had fallen to 77.4 plus or minus 6.6% of its value 15 minutes
postocclusion. In seven experimental dogs, two branches of the LAD were
occluded. Fifteen minutes after double occlusion, one occlusion was
released; 30 min after the initial occlusion PresigmaST had fallen
significantly more than control, to 43.1 plus or minus 13.1% of its value
15 minutes postocclusion. Simultaneously, epicardial sites in the
reperfused area also showed normalization of ST segments and 24 hours later
exhibited normal myocardial creatine phosphokinase activity and normal
histologic appearance. During the same experiment, the mean precordial R
wave voltage of sites with ST-segment elevations exceeding 0.15 mV 15
minutes following occlusion fell significantly (P less than 0.05) more in
the control group (from 1.14 plus or minus 0.15 to 0.75 plus or minus 0.06
mV) than in the reperfused group (from 1.06 plus or minus 0.09 to 0.96 plus
or minus 0.17 mV) during the ensuing 45 minutes. Thus, more rapid
normalization of PresigmaST or preservation of precordial R wave voltage
reflected the actual prevention of myocardial necrosis by reperfusion.
These findings demonstrate the usefulness of precordial
electrocardiographic mapping for evaluation changes in myocardial ischemic
injury. Sites at which appearance of epicardial ST segment is not a
reliable index of ischemic injury were associated with the development of
intraventricular conduction blocks with Q to intrinsic deflection intervals
exceeding 40 mesc or QRS durations exceeding 65 msec; these changes were
associated with precordial RSR' configurations. Such sites, whether
recorded from precordial or epicardial leads, should be excluded from
ST-segment measurements used in the assessment of myocardial ischemia.
ARTICLES
Evaluation of precordial electrocardiographic mapping as a means of assessing changes in myocardial ischemic injury
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