SENSITIVITY AND SPECIFICITY OF VECTORCARDIOGRAPHY IN DIAGNOSTICS OF ACUTE MYOCARDIAL INFARCTION COMORBID WITH LIVER STEATOSIS AND NON-ALCOHOLIC STEATOHEPATITIS

Abstract

Aim. To reveal vectorcardiographic (VCG) signs of an acute widespread myocardial infarction (MI) with Q, of the anterior wall of the left ventricle (LV), comorbid with hepatic steatosis and non-alcoholic steatohepatits, and to estimate the specificity and sensitivity of the method in diagnostics of comorbid pathology.Material and methods. Totally, 14 patients studied with primary widespread MI of the anterior wall of LV (1st group), mean age — 69±3 y.; 43 patients with comorbid course of primary MI of anterior wall and hepatic steatosis or non-alcoholic steatohepatitis (2nd group) — mean age 66±2 y. In both groups women predominated. Instrumental study included electrocardiography, VCG, echocardiography and ultrasound liver examination. VCG performed on a modern cardiodiagnostic multifunctional equipment MTM-SKM. For estimation of sensitivity and specificity of VCG the four-pole net was applied.Results. In comorbidity patients via VCG there was shifting of QRS loop down-, right- and backwards with a decrease of collected square 2,1 times (p<0,001); appearance of local ventricular block; disturbance of repolarization appearing as ST-damage vector, directed right-up-frontwards (51,2%) and left-frontwards (48,8%), changes of T-loops location, angular QRS-T loops direction in VА1,2,4,5 (p<0,05-0,001), increase of T-loops square 2,9-3,0 times in VА2,3,5 (p<0,01), of their cross and condensation of timing marks by their trace in all projections (p<0,001). Rarefaction of time points in the area of baseline shift of the loop in VА1,4,5 (p<0,05- 0,001), increase of the loops QRS square in VА5 (p<0,01) and loops P in VА1-3 2,4-3,2 times (p<0,01) witness hemodynamic overload of basal areas of both ventricles, higher areas of front and lateral walls of LV, and also atriums. VCG let to diagnose non-transmural involvement of myocardium in all patients with comorbid pathology. In 2nd group patients, comparing to the 1st group, there is rarefaction of time marks in the area of baseline shifts of QRS loops in anterior projection (p<0,01), that represents overload in upper areas of LV front wall. In echocardiography it is found that left chambers increase (p<0,001), there is diastolic dysfunction (relaxation disorder of LV — 40%), pseudonormal type — 32%, restrictive type — 28%) with systolic function impairment (p<0,001). Sensitivity of vectrocardiography was 98,5%, and specificity — 95,2%.Conclusion. Application of enhanced cardiodiagnostic complex MTM-SKM and vector analysis of electromotive force made it, with sensitivity 98,5% and specificity 95,2%, to reveal and clarify the depth and spread of myocardial damage, additionally to electro- and echocardiographic methods, and to obtain information on the heart condition outside necrosis zone.

Keywords

• myocardial infarction
• hepatic steatosis
• non-alcoholic steatohepatitis
• electrocardiography
• vectorcardiography
• echocardiography