G-3985

2025-10-19 19:36

Written by ARCIMS 26 ARCIMS 26 in Sunday 2025-10-19 19:36

Less recognized ECG changes associated with major ischemia according to Minnesota coding system

 Muhammad Islampanah 1 ℗, Sara Saffar Soflaei 2, Azadeh Izadi-Moud 3, Pooria Salehi-Sangani 1, Ghazaleh Pourali 4, Asal Yadollahi 3, Helia Rezaeifard 2, Gordon A. Ferns 5, Majid Ghayour-Mobarhan 6 ©, Mohsen Moohebati 7   

1  Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2  International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran

3  Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4  Metabolic Syndrome Research Center, Mashhad University of Medical Science, Mashhad, Iran

5  Brighton and Sussex Medical School, Division of Medical Education, Brighton, UK

6  International UNESCO Center for Health-Related Basic Sciences and Human Nutrition Mashhad University of Medical Sciences; Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

7  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

Email: muhammad.iriran@gmail.com
 

 

 
Abstract

Introduction: The electrocardiogram (ECG) remains a widely accessible, non-invasive, and cost-effective modality for detecting coronary artery disease (CAD). While classic ECG features of myocardial ischemia are well established, this study aimed to identify less recognized ECG abnormalities potentially associated with major myocardial ischemia. Methods: This cross-sectional analysis utilized data from the MASHAD cohort. Clinical and biochemical variables—including fasting blood glucose, lipid profile, and histories of diabetes, hypertension, and cardiovascular disease—were recorded. Standard 12-lead ECGs were interpreted using the Minnesota (MN) coding system. Participants were classified based on the presence or absence of major ischemic changes. Statistical significance was defined as p 0.05. Results: Among 9,035 ECGs analyzed, 1,276 (14.1%) exhibited major ischemic changes. Backward stepwise logistic regression revealed significant associations between major ischemia and left axis deviation (OR = 2.482, p 0.001), right axis deviation (OR = 2.757, p = 0.023), left ventricular hypertrophy (OR = 2.171, p = 0.020), and right ventricular hypertrophy (OR = 5.747, p = 0.004). Additionally, minor T-wave abnormalities (OR = 3.249, p 0.001), left anterior hemiblock (OR = 4.711, p = 0.001), and notched or widened P waves (OR = 2.415, p 0.001) were independently associated with major ischemia. Conclusion: Several underrecognized ECG findings—including axis deviations, ventricular hypertrophy, and conduction abnormalities—were significantly associated with major myocardial ischemia. These findings may offer additional diagnostic value and warrant further longitudinal validation in CAD populations.


Keywords: Myocardial Ischemia, Electrocardiogram, Minnesota Codes, Coronary Artery Disease

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