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Vectorcardiography is Superior to Conventional ECG for Detection of Myocardial Injury after Coronary Surgery
Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
Östergötlands Läns Landsting, Heart Centre.
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2001 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 35, no 2, 125-128 p.Article in journal (Refereed) Published
Abstract [en]

Objective - The reliability of conventional scalar ECG for diagnosis of perioperative myocardial infarction (PMI) in cardiac surgery has been questioned. For the diagnosis of myocardial infarction in general vectorcardiography (VCG) is superior to ECG. Therefore, the usefulness of conventional VCG and computerized analysis of spatial VCG changes for diagnosis of PMI were studied.

Design - VCG registrations were obtained from 218 patients undergoing coronary surgery. The spatial QRS vector loop area of each VCG registration was calculated and the loop area before surgery compared with the loop area after surgery. Conventional VCG criteria for myocardial infarction and set values for loop area reduction were related to sustained elevation of plasma troponin-T and clinical course.

Results - Both conventional VCG criteria and spatial changes translated better than Q-waves on scalar ECG into elevation of biochemical markers of myocardial injury and impaired clinical course.

Conclusion - VCG appears superior to conventional ECG as regards detection of myocardial injury in coronary surgery. Computerized programs have facilitated the registration and the interpretation of VCG and this methodology deserves further evaluation in cardiac surgery.

Place, publisher, year, edition, pages
2001. Vol. 35, no 2, 125-128 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-26844DOI: 10.1080/140174301750164835Local ID: 11462OAI: oai:DiVA.org:liu-26844DiVA: diva2:247394
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Perioperative myocardial infarction in cardiac surgery: a diagnostic dilemma
Open this publication in new window or tab >>Perioperative myocardial infarction in cardiac surgery: a diagnostic dilemma
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Perioperative myocardial infarction remains a major cause of morbidity and mortality after cardiac surgery. In spite of this there is no consensus regarding diagnostic criteria and consequently the reported incidence varies widely. In this thesis risk factors for PMI and outcome after PMI were studied in a retrospective case control study on 42 patients fulfilling strict criteria for PM! collected from a cohort of 1147 adult cardiac surgical patients. Traditional diagnostic criteria for PMI, release characteristics of biochemical markers for myocardial injury and VCG were evaluated in a prospective study on 302 consecutive patients undergoing isolated frrst time CABG. PM! was found to be a problem mainly associated with surgery for ischaemic heart disease. Unstable angina and unfavourable conditions for revascularisation were found to be the most important risk factors for PMI. Patients with PM! had an impaired short-term and mid-term outcome compared with controls. In the prospective study a sustained elevation of troponin-T was used as a marker for permanent myocardial damage. It was demonstrated that Q-wave criteria, previously accepted as the gold standard for diagnosis of PM!, correlated poorly with biochemical markers of myocardial injury and clinical outcome. One fourth of the patients with new Q-waves after CABG had no evidence of permanent myocardial injury. The use of biochemical markers for early diagnosis of myocardial injury is interfered by unspecific release unrelated to permanent myocardial damage. However, little is known about the magnitude of this "diagnostic noise". To address this issue a subgroup with no or minimal permanent myocardial damage was identified by use of the unique release characteristics of troponin-T. The time frame of unspecific release and the plasma levels of CKMB and troponin-T caused by unspecific release were assessed. A substantial early release of both CKMB and troponin-T nnrelated to permanent myocardial injury was found. As the unspecific release can be expected to differ depending on type of cardiac intervention this type of knowledge may prevent inappropriate comparisons. Repeated early sampling for CKMB provided additional information of value for early identification of patients who would later show sustained elevation of troponin-T. VCG was found to correlate better with sustained levels oftroponin-T and clinical outcome than scalar ECG. To conclude, diagnostic pitfalls associated with both ECG and enzymatic diagnosis of PM! were addressed and novel approaches to improve detection of permanent myocardial damage are suggested.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2001. 54 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 668
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27472 (URN)12125 (Local ID)91-7219-961-X (ISBN)12125 (Archive number)12125 (OAI)
Public defence
2001-04-20, Berzeliussalen, Universitetssjukhuset, Linköping, 13:15 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-06Bibliographically approved

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Dahlin, Lars-GöranNylander, EvaRutberg, HansSvedjeholm, Rolf

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