Simulation of ST segment changes during subendocardial ischemia using a realistic 3-D cardiac geometry.

The mechanisms underlying the ST segment shifts associated with subendocardial ischemia remain unclear. The aim of this paper is to shed further light on the subject through numerical simulations of these shifts. A realistic three-dimensional model of the ventricles, including fiber rotation and anisotropy, is embedded in a nonhomogeneous torso model. A simplification of the bidomain model is used to calculate only the ST segment shift, assuming known values of the transmembrane potential during the plateau and rest phases. A similar simulation is performed in two dimensions. The simulation results suggest that subendocardial ischemia can be located by ST segment shift on the epicardial and torso surfaces. It is shown that ST elevation is associated with the transmural ischemic boundary, while ST depression is associated with the lateral ischemic boundaries.