Abstract
Background
ST elevation (STE) on the electrocardiogram (ECG) may be due to acute myocardial infarction
(AMI) or other nonischemic pathologies such as left ventricular aneurysm (LVA). The
objective of this study was to validate 2 previously derived ECG rules to distinguish
AMI from LVA. The first rule states that if the sum of T-wave amplitudes in leads
V1 to V4 divided by the sum of QRS amplitudes in leads V1 to V4 is greater than 0.22,
then acute ST-segment elevation MI is predicted. The second rule states that if any
1 lead (V1-V4) has a T-wave amplitude to QRS amplitude ratio greater than or equal
to 0.36, then acute ST-segment elevation MI is predicted.
Methods
This was a retrospective analysis of patients with AMI (n = 59) and LVA (n = 16) who
presented with ischemic symptoms and STE on the ECG. For each ECG, the T-wave amplitude
and QRS amplitude in leads V1 to V4 were measured. These measurements were applied
to the 2 ECG rules; and sensitivity, specificity, and accuracy in predicting AMI vs
LVA were calculated.
Results
For rule 1 (sum of ratios in V1-V4), sensitivity was 91.5%, specificity was 68.8%,
and accuracy was 86.7% in predicting AMI. For rule 2 (maximum ratio in V1-V4), sensitivity
was 91.5%, specificity was 81.3%, and accuracy was 89.3% in predicting AMI.
Conclusions
When patients present to the emergency department with ischemic symptoms and the differential
diagnosis for STE on the ECG is AMI vs LVA, these 2 ECG rules may be helpful in differentiating
these 2 pathologies. Both rules are highly sensitive and accurate in predicting AMI
vs LVA.
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Article Info
Publication History
Published online: March 27, 2015
Accepted:
March 19,
2015
Received in revised form:
March 19,
2015
Received:
February 18,
2015
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
