The value of perioperative ECG in patients with complicated forms of coronary artery disease

Abstract

The aim: to analyze the informativeness and features of the perioperative electrocardiogram dynamics in complicated forms of coronary artery disease (CAD). Material and methods: retrospective ECG analysis of 100 randomized high-risk patients with complicated forms of CAD who underwent surgery in the National M. Amosov Institute of Cardiovascular Surgery Affiliated to National Academy of Medical Sciences of Ukraine from 2009 to 2019. All the patients included in the study were classified as high-risk group for complications and mortality and had an average risk of 8.60 % (from 5.02 % to 39.38 %) according to the EuroSCORE II scale. Results. Postinfarction left ventricular aneurysm (ALV) was localized in the anteroseptal region of the left ventricle (LV) in 94 (94 %) cases, and posterior-basal LV aneurysm (PBALV) was diagnosed in 6 (6 %) patients. Mitral insufficiency (MI) was detected in 8 (8.5 %) patients with anterior ALV and in 2 (33.3 %) cases of PBALV. Tricuspid valve insufficiency (TI) was diagnosed in 4 (4.2 %) patients with anterior ALV, and postinfarction defect of the interventricular septum (VSD) was verified in 2 (33.3 %) patients with PBALV. Diagnostics of anteroseptal ALV using ECG is highly accurate, the specificity of the method is 94 %, and the sensitivity is 95.6 %. ECG interpretation after surgery presents with certain difficulties, since nonspecific changes of the terminal part of the ventricular complex often occur that being interpreted correctly determine further treatment tactics. Positive ECG dynamics was detected in 66 (66 %) patients in the form of improved intraventricular conduction and the appearance of the R wave in leads I, avL, V2-V6, a lack of dynamics – in 11 (11 %), as a rule, in patients with complete left bundle branch block (LBBB), dry pericarditis of II–III stage was diagnosed in 23 (23 %) patients. Conclusions. ECG retains its importance and remains an informative and available method in modern cardiology. The correct ECG interpretation before surgery helps to assess the initial severity of the condition and timely correct the therapy and management tactics in the early postoperative period.