the relationship of the changes in lateral leads i and avl in electrocardiogram with echocardiography and coronary angiography findings in patients with acute coronary syndrome

Background: electrocardiographic (ecg) study is a principle for the symptoms contributed to the acute myocardial infarction (ami)/acute coronary syndrome (acs). the diagnosis of involved coronary artery based on ecg changes is still a challenge. this study is aimed to evaluate the association of mere changes in i and avl leads with the involved region found through echocardiography and involved coronary artery through angiography.methods: this cross-sectional study was conducted on 100 patients referred with ami/acs symptoms that had mere ecg changes in i and avl leads (st elevation + q wave/st depression + inverted-t). transthoracic echocardiography (tte) and coronary angiography (cag) were performed for the patients. the correlation of ecg with echocardiography and angiography was assessed.results: among the studied population, 39 patients (39%) were women with the mean ± standard deviation (sd) of age of 64.60 ± 9.39 years. there was no significant association between ecg changes in leads i and avl with neither the stenosis of first diagonal (d1) coronary artery found through angiography (p = 0.580) nor the mid-anterior wall dyskinesia found through echocardiography (p = 0.380). a remarkable association between the echocardiographic findings representing mid-anterior wall ischemic dyskinesia with the stenosis of d1 coronary artery was detected (p < 0.001). the sensitivity, specificity, positive predictive value (ppv), and negative predictive value (npv) of 100%, 54.54%, 94.68%, and 100% were respectively found as the diagnostic values of mentioned factors.conclusion: our findings showed significant association between d1 involvement and mid-anterior dyskinesia in echocardiography, while the changes in ecg were associated neither with echocardiographic nor angiographic outcomes.