Clinical Value of 18-Lead Electrocardiogram Combined with Echocardiography in Diagnosing Coronary Heart Disease with Myocardial Ischemia and Localizing Culprit Vessels
LI Xiaomin
Department of Electrocardiography, Xun County People's Hospital, Hebi Henan 456250
Abstract：【Objective】 To explore the clinical value of 18-lead electrocardiogram (ECG) combined with echocardiography in diagnosing coronary heart disease (CHD) complicated with myocardial ischemia and localizing culprit vessels. 【Methods】 A total of 82 patients with suspected CHD scheduled for coronary angiography admitted to our hospital from June 2023 to January 2025 were prospectively enrolled. According to coronary angiography findings, patients were divided into observation group (hemodynamically significant stenosis, n=56) and control group (no significant stenosis, n=26). The diagnostic performance of 18-lead ECG, echocardiography and their combination (defined as positive if either test showed positive result) was compared. Hierarchical Logistic regression models were established: Model 1 contained clinical baseline data; Model 2 added 12-lead ST-T changes based on Model 1; Model 3 supplemented ST-T abnormalities from additional leads of 18-lead ECG on the basis of Model 2; Model 4 incorporated echocardiographic wall motion abnormalities into Model 3. The area under the receiver operating characteristic curve (AUC) and incremental diagnostic value of each model were analyzed. 【Results】 Fifty-six patients were confirmed to have hemodynamically significant coronary stenosis. For the diagnosis of myocardial ischemia, 18-lead ECG yielded a sensitivity of 76.79%, specificity of 73.08% and AUC of 0.749; echocardiography showed a sensitivity of 73.21%, specificity of 76.92% and AUC of 0.751. Combined detection achieved a higher sensitivity of 91.07%, specificity of 69.23% and AUC of 0.802, which were all superior to single examination (P<0.05). The AUC values of Model 1 to Model 4 were 0.702, 0.752, 0.781 and 0.832 respectively. Compared with Model 4, Model 1, Model 2 and Model 3 had significantly lower AUCs with DeLong test P values of 0.004, 0.021 and 0.047 separately. The variance inflation factor (VIF) of all models was less than 5 without obvious multicollinearity, and the Hosmer-Lemeshow test showed P>0.05 for all models. 【Conclusion】 In patients admitted to chest pain center, 18-lead ECG and echocardiography have respective advantages in identifying hemodynamically significant myocardial ischemia in CHD patients. Their combination presents favorable overall diagnostic efficiency, which can be applied as a comprehensive evaluation protocol for patients with moderate-to-high risk suspected coronary heart disease.
李晓敏. 18导联心电图联合超声心动图诊断冠心病心肌缺血及责任血管定位的临床价值[J]. 医学临床研究, 2026, 43(6): 983-986.
LI Xiaomin. Clinical Value of 18-Lead Electrocardiogram Combined with Echocardiography in Diagnosing Coronary Heart Disease with Myocardial Ischemia and Localizing Culprit Vessels. JOURNAL OF CLINICAL RESEARCH, 2026, 43(6): 983-986.
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2026, Vol. 43 
