Circulation, Vol 53, 235-240, Copyright © 1976 by American Heart Association
HR Phillips, JW Starr, VS Behar, A Walston 2d, JC Greenfield Jr and GS Wagner
Vectorcardiograms (VCG) from a consecutive group of 77 patients with
significant aortic valve disease were analyzed. All of the patients had
complete left and right heart catheterization with normal coronary
arteriograms and normal left ventricular contraction. Thirty-five (46%)
patients met VCG criteria for anterior myocardial infarction (AMI-35%)
and/or inferior myocardial infarction (IMI-14%). This was a significant
increase in false positive diagnosis for both criteria compared to a group
of 200 normal volunteers under age 30 and 100 patients with normal hearts
by cardiac catheterization (P less than 0.01). It was found that if the VCG
diagnosis of myocardial infarction was deferred when the maximal transverse
plane magnitude was greater than 1.9 mV, the incidence of AMI false
positive diagnosis decreased to 3% and the incidence of IMI false positive
diagnosis decreased to 1%. The same rule was applied to the aortic valve
disease cohort, a group of 124 patients with documented AMI and a group of
158 patients with IMI. This decreased the sensitivity of the AMI criteria
from 93 to 83% and of the IMI criteria from 85 to 77%. The increase in
average performance was statistically significant fro the AMI criteria (P
less than 0.05) but not for the IMI criteria.
ARTICLES
Evaluation of vectorcardiographic criteria for the diagnosis of myocardial infarction in the presence of left ventricular hypertrophy