A Clinical Appraisal of the Vectorcardiogram in Myocardial Infarction

Hugenholtz, Paul G.; Whipple, Gerald H.; Levine, Harold D.

doi:10.1161/01.cir.24.4.808

Cited by 65 publications

(16 citation statements)

References 31 publications

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“…Preliminary observations have indicated that the use of the VCG criteria herein proposed together with the criteria previously published, 8,9 related to the early part of the QRS st loop, results in a very high yield of positive diagnoses without overlap with values found in normals. A study is now in progress evaluating the combined use of early and late VCG QRS changes in the diagnosis of myocardial infarction in the inferior and other areas of the heart.…”

Section: Discussionmentioning

confidence: 74%

The Frontal Plane Vectorcardiogram in Old Inferior Myocardial Infarction

et al. 1970

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Section: Discussionmentioning

confidence: 74%

The Frontal Plane Vectorcardiogram in Old Inferior Myocardial Infarction

et al. 1970

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“…Superior forces for >30 ms and clockwise inscription of the first 25 to 30 ms in the frontal plane have been proposed as sensitive criteria for inferior infarction (McConahay et al, 1970;Young and Williams, 1968;Hugenholtz, Forkner, and Levine, 1961;Murata et al, 1967). It has been suggested that the vectorcardiographic appearance of inferior infarction is preserved in the presence of left anterior hemiblock (Kulbertus et al, 1971).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic criteria for computer-aided electrocardiographic 15-lead system. Evaluation using 12 leads and Frank orthogonal leads with vector display.

Talbot¹,

Dreifus²,

Watanabe³

et al. 1976

Heart

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The criteria for the diagnosis of myocardial infarction and ischaemic heart disease by an automated 15-lead computer-aided electrocardiographic system were examined using electrocardiograms of 543 patients. Errors in the electrocardiographic diagnosis were evaluated for each lead system (Frank orthogonal 3-lead, 12-lead, and hybrid 15-lead) using clinical and catheterization data for definitive diagnosis before review of the electrocardiograms and their reports. The effects of combinations of these diagnoses and additional ventricular conduction defects were also studied.Myocardial infarction and left ventricular hypertrophy were more reliably diagnosed using 3-lead and 12-lead systems together than with either system alone. The most sensitive criteria for anterior infarction were a Q/R ratio in Z < 0-1 and loss of the first 20 ms of anteriorforces in the horizontal and sagittal planes of the vectorcardiogram. However, false positive results were frequent, particularly in association with left ventricular hypertrophy, non-specific intraventricular conduction defects, and left bundle-branch system block. Our V lead criteria were more specific whether or not these associated conditions were present. No single criterion with an acceptablefalse positive rate could befound to be sensitivefor inferior infarction in all situations. Our most sensitive criteria were those based on the limb leads, and the presence of superior forces for the first 30 ms in the frontal plane of the vectorcardiogram, but these were better in combination. Limb lead criteria were the most specific. False positive results for inferior infarction were more frequent in the presence of left ventricular hypertrophy or ventricular conduction defects other than left anterior hemiblock.ST and Twave abnormalities were more apparent in the 12 leads than in the orthogonal leads. Specificity and sensitivity of criteria were poor, and specificity was decreased and sensitivity was not significantly improved by combining 3-lead with 12-lead criteria. Because of frequent measurement errors of ST, T, and also Q waves by the computer programme, in practice we have achieved increased sensitivity in the diagnosis of ischaemia and infarction with the combination of 3-lead and 12-lead systems.It is concluded that errors of diagnosis by a computer-aided system can be reduced by using multiple leads and that both 12-lead and orthogonal 3-lead systems are necessary for optimal computer diagnosis of left ventricular hypertrophy, myocardial infarction, and ischaemia.There is still controversy over the relative merits such analysis, but the 12 praecordial and limb of 3-lead and 12-lead systems for computer electro-leads are more familiar to physicians. Comparisons cardiographic diagnosis (Caceres and Hochberg, of waveform measurements have suggested that 1970; Smith and Hyde, 1969;Bonner et al., 1972; the orthogonal system provides nearly all the Cornfield et al., Pordy et al., 1968). The information obtained from the 12-lead system in orthogonal 3-lead system is the sim...

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“…The diagnosis criteria for inferior lateral myocardial infarction were those of Chou et al [3] and for anteroseptal myocar dial infarction those of Hugenholtz et al [4]. The diagnosis of left anterior hemiblock and inferior myocardial infarction were accord ing to Friedman's suggestion [5].…”

Section: Vectorcardiogrammentioning

confidence: 99%

Vectorcardiogram versus Thallium-201 Planar Scintigram and Single-Photon Emission Computed Tomogram in the Diagnosis of Inferior Myocardial Infarction

Carson¹,

Soper²,

Rajagopalan³

1990

Am J Noninvas Cardiol

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After their first inferior myocardial infarction, 34 patients were studied by vectorcardiography, thallium- 201 planar scintigraphy and 360° data acquisition of single-photon emission computed tomography (SPECT). In 24 patients, the diagnosis from thallium-201 planar scintigrams was the same as vectorcardiographic diagnosis. However, in 32 patients, the diagnoses by vectorcardiography and SPECT were identical. This result indicates: (1) thallium-201 SPECT images are better than planar scintigrams in detecting the infarcted location and correlate closely with the vectorcardiographic diagnosis; (2) the 3-dimensional analysis of the SPECT images can supply anatomical information to explain the 3-dimensional electrical activity of the vectorcardiogram; (3) since the vectorcardiogram represents 3-dimensional electrical activity, it is clearly unsatisfactory to use planar thallium-201 images which represent, in 2 dimensions, a 3-dimensional structure to compare perfusion with electrical activity; (4) islands of viable tissue within myocardial necrosis may be an important reserve of electrical activity. Therefore, the contraction (healing) of necrotic tissue and the reactive hypertrophy of myocardial islands and the residual myocardium after infarction may be the underlying mechanism of time-normalized electrocardiogram; a further follow-up SPECT study may provide evidence to support this hypothesis.

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A Clinical Appraisal of the Vectorcardiogram in Myocardial Infarction

Cited by 65 publications

References 31 publications

The Frontal Plane Vectorcardiogram in Old Inferior Myocardial Infarction

The Frontal Plane Vectorcardiogram in Old Inferior Myocardial Infarction

Diagnostic criteria for computer-aided electrocardiographic 15-lead system. Evaluation using 12 leads and Frank orthogonal leads with vector display.

Vectorcardiogram versus Thallium-201 Planar Scintigram and Single-Photon Emission Computed Tomogram in the Diagnosis of Inferior Myocardial Infarction

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