Significance of lead aVR ST segment elevation in acute coronary syndrome

Department of Cardiology, Cardiac Unit, Chest Disease Institute, Nonthaburi, Thailand.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 10/2005; 88(10):1382-7.
Source: PubMed


To study the relation between lead aVR ST segment elevation (aVRSTE) and angiographic_coronary artery lesions in patients with acute coronary syndrome (ACS).
From January 2001 to December 2001, the authors retrospectively studied 26 consecutive patients who were admitted to the coronary care unit, Chest Disease Institute with ACS. The admission 12-lead EKGs,chest X-ray, troponin T, creatine phosphokinase (CPK), creatine kinase MB fraction (CK MB) and blood chemistry including fasting blood sugar, renal function test (BUN and creatinine), electrolytes and lipid profiles were obtained and analyzed before coronary angiogram. CAG was performed in all within 48 hours after admission. The admission 12-lead EKGs and angiographic coronary artery lesions were analyzed.
There were 26 patients (M:F = 21:5) with a mean age of 64 +/- 9 yr. The culprit lesions were located at the left main coronary artery (LM) in 5 (19%), the left anterior descending artery (LAD) in 8 (31%), the right coronary artery (RCA) in 11 (42%) and the left circumflex artery (LCX) in 2 (8%). Of these, aVRSTE (> 0.1 mV) was detected in 9 (35%), 4 in the LM group (80%). 3 in the RCA group (27%) and 2 in the LAD group (25%). The findings of aVRSTE distinguished the LM group from the non LM group (LAD, RCA and LCX), with 80% sensitivity, 76% specificity and 77% accuracy.
In patients with acute coronary syndrome, lead AVR ST segment elevation is associated with the culprit left main coronary lesion.

Download full-text


Available from: Kriengkrai Hengrussamee
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Lead aVR is a neglected, however, potentially useful tool in electrocardiography. Our aim was to evaluate its value in clinical practice, by reviewing existing literature regarding its utility for identifying the culprit lesion in acute myocardial infarction (AMI). Methods: Based on a systematic search strategy, 16 studies were assessed with the intent to pool data; diagnostic test rates were calculated as key results. Results: Five studies investigated if ST-segment elevation (STE) in aVR is valuable for the diagnosis of left main stem stenosis (LMS) in non–ST-segment AMI (NSTEMI). The studies were too heterogeneous to pool, but the individual studies all showed that STE in aVR has a high negative predictive value (NPV) for LMS. Six studies evaluated if STE in aVR is valuable for distinguishing proximal from distal lesions in the left anterior descending artery (LAD) in anterior ST-segment elevation AMI (STEMI). Pooled data showed a sensitivity of 47%, a specificity of 96%, a positive predicative value (PPV) of 91% and a NPV of 69%. Five studies examined if ST-segment depression (STD) in lead aVR is valuable for discerning lesions in the circumflex artery from those in the right coronary artery in inferior STEMI. Pooled data showed a sensitivity of 37%, a specificity of 86%, a PPV of 42%, and an NPV of 83%. Conclusion: The absence of aVR STE appears to exclude LMS as the underlying cause in NSTEMI; in the context of anterior STEMI, its presence indicates a culprit lesion in the proximal segment of LAD.
    Full-text · Article · Jun 2009 · Annals of Noninvasive Electrocardiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Several studies suggest that electrocardiographers tend to neglect lead aVR during the reading of electrocardiograms (ECGs). Our objective was to provide a systematic review of the most important diagnostic and prognostic uses of lead aVR. We performed a thorough review of the literature about the lead aVR using PubMed, MEDLINE and the archives of the University at Buffalo libraries. We found that lead aVR may provide important additional information in the diagnosis of coronary artery disease. It may provide a clue to the location of a lesion as well as the possibility of three vessel disease during an acute coronary syndrome. Lead aVR was found useful in the locus of arrhythmias and in differentiation of narrow and wide QRS complex tachycardias. It provides useful prognostic information for patients with the Brugada syndrome and tricyclic antidepressant toxicity. Lead aVR provides alternative criteria for the electrocardiographic diagnosis of left ventricular hypertrophy and left anterior fascicular block. Lead aVR provides very important additional diagnostic and prognostic information in multiple cardiac conditions and can be used either alone or in conjunction with other electrocardiographic leads.
    No preview · Article · Apr 2010 · Annals of Noninvasive Electrocardiology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Acute coronary syndrome remains the leading cause of morbidity and mortality worldwide. It will continue to rise as the prevalence of patients with obesity and diabetes increases. Patients with non-ST segment elevation acute coronary syndrome had a bad prognosis in patients with left main ± three vessel diseases, so early identification of these patients by electrocardiography if ST segment elevation in lead aVR ⩾0.5 m and maximal QRS duration of ⩾90 ms is important for the selection of optimal treatment.
    Preview · Article · Jun 2011 · Egyptian Heart Journal
Show more