Less Recognized ECG Changes Associated with Significant Ischemia; Concerning the Minnesota Coding System
نویسندگان
1 Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
3 Heart and Vascular Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
4 Metabolic Syndrome Research Center, Mashhad University of Medical Science, Mashhad, Iran
5 Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
6 International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
7 Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
8 Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
9 Brighton and Sussex Medical School, Division of Medical Education, Brighton, UK
10 Metabolic Syndrome Research Center, Mashhad University of Medical Science, Mashhad, Iran
11 International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
doi
10.30483/rjm.2025.254652.1426چکیده
Background: An electrocardiogram (ECG) is a commonly used, noninvasive, cost-effective tool widely available for diagnosing patients with coronary artery disease. It is associated with significant myocardial ischemia due to Coronary artery disease (CAD), which is associated with specific ECG changes. Objectives: The goals were to determine less well-known ECG changes associated with significant ischemia and assess their potential value as early markers for diagnosing myocardial ischemia in patients with CAD. Methods: Data were obtained from participants in the MASHAD cohort study. The characteristics obtained, including fasting blood glucose, lipid profile, history of diabetes mellitus, history of hypertension, and history of previous CVD, were recorded. A 12-lead ECG was also obtained for each subject and coded for specific ECG changes using Minnesota (MN) codes. Patients were divided into two groups based on MN coding for significant ischemia. A p-value less than 0.05 was considered significant. Results: Out of 9035 coded ECGs,1276 (14.1%) had significant myocardial ischemia. After applying backward binary logistic regression, left- and right-axis deviations were significantly associated with significant ischemia (OR=2.482, p<0.001; OR=2.757, p=0.023, respectively). Left Ventricular (OR=2.171, p=0.020) and right ventricular hypertrophy (OR=5.747, p=0.004) showed significant associations. Other indicators, including minor T-wave abnormalities (OR=3.249, p<0.001), left anterior hemiblock (OR=4.711, p=0.001), and notched and widened P wave (OR=2.415, p<0.001), were also significantly associated with significant ischemia. Conclusion: These findings suggest that the identified ECG changes may serve as novel indicators or associated markers of central ischemia. However, more longitudinal studies are needed to evaluate each of these abnormalities in patients with CAD.
