Positional changes of spatial QRS- and ST-segment variables in normal subjects: implications for continuous vectorcardiography monitoring during myocardial ischemia

Electrocardiographic QRS- and ST-segment changes are to be expected during changes in body posture. We prospectively analyzed the influence of changes in body position on continuous vectorcardiography monitoring of QRS-vector difference (QRS-VD) and ST change-vector magnitude (STC-VM) according to the currently used criteria of myocardial ischemia in 21 normal subjects. Fifteen (71%) and 6 (29%) subjects had significant positional QRS-VD and STC-VM changes, respectively. Vectorcardiography changes were most frequent and pronounced in the left lateral position. An alternative to the existing criterion of ischemia is proposed to improve the specificity of STC-VM. Subjects with positional QRS-VD changes had higher mean STC-VM values as compared with those without such changes. Otherwise no characteristics among those with positional vectorcardiography changes could be identified. There was no statistically significant association between positional QRS-VD and STC-VM changes (R = .13, P = .57). We conclude that the clinical use of QRS-VD in its present form for continuous vectorcardiography monitoring of myocardial ischemia seems to be of limited practical value, because of the presence of frequent "pseudo-ischemic" changes. STC-VM seems to have a significant potential of continuous vectorcardiography monitoring. However, an indicator of body position change or even an algorithm enabling on-line correction for positional vectorcardiography changes seems to be essential to improve the accuracy of this technique in identifying myocardial ischemia.