A synthesized 18-lead ECG obtained after a Master two-step exercise test successfully identified the right coronary and left circumflex arteries as the culprit vessels for myocardial ischemia.
Case Report (n=1)
No
Does a synthesized 18-lead electrocardiogram obtained after exercise stress testing improve the identification of culprit coronary arteries in a patient with effort angina?
Synthesized 18-lead ECG during exercise stress testing may enhance the detection and localization of myocardial ischemia compared to standard 12-lead ECG.
A synthesized 18-lead electrocardiograph is a specialized technology that mathematically computes the virtual electrocardiographic waveforms of the right chest leads (V3R, V4R, and V5R) and posterior leads (V7, V8, and V9) based on a standard 12-lead electrocardiograph input without additional lead placement or techniques. Synthesized 18-lead electrocardiography is a useful test for the identification of the culprit coronary arteries in patients with ST-segment elevation myocardial infarction of the right ventricular wall or the posterior/lateral left ventricular wall, which are often missed on standard 12-lead electrocardiography. However, few studies have examined the usefulness of this modality during exercise stress testing. We present a case of a 78-year-old man with a two-month history of typical angina. The synthesized 18-lead electrocardiogram obtained just after the Master two-step exercise test revealed ST-segment shifts in multiple leads, including synthesized V4R, V5R, and V7-9 leads, and U-wave changes in some leads, including the synthesized V9 lead. The diagnosis of the culprit coronary arteries causing exercise-induced myocardial ischemia is discussed with reference to coronary angiographic findings. This modality could potentially increase the sensitivity and specificity for the detection of coronary artery disease and accurately pinpoint the site of the lesion. If an electrocardiograph can display a synthesized 18-lead electrocardiogram, it should be used when evaluating the waveform due to myocardial ischemia.
Takahashi et al. (Fri,) conducted a case report in Effort angina (n=1). Synthesized 18-lead electrocardiogram after Master two-step exercise test was evaluated on Identification of culprit coronary arteries causing exercise-induced myocardial ischemia. A synthesized 18-lead ECG obtained after a Master two-step exercise test successfully identified the right coronary and left circumflex arteries as the culprit vessels for myocardial ischemia.