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Yang N, Han X, Zhang J, Zhang S, Sun J. What can we find in QRS in patients with ST-segment-elevation myocardial infarction? J Electrocardiol 2022. [DOI: 10.1016/j.jelectrocard.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Han X, Chen Z, Wang Y, Zhang J, Zhang Y, Su Q, Pan Z, Sun J, Wang Y. Prognostic significance of QRS distortion and frontal QRS-T angle in patients with ST-elevation myocardial infarction. Int J Cardiol 2021; 345:1-6. [PMID: 34715207 DOI: 10.1016/j.ijcard.2021.10.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/27/2021] [Accepted: 10/22/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND QRS distortion (G3I) and frontal QRS-T angle (fQRS-T angle) are both electrocardiographic (ECG) signs of ongoing ischemia and depolarization-repolarization heterogeneity, which always occur in patients with ST-segment elevation acute myocardial infarction (STEMI). METHODS We retrospectively collected 592 STEMI patients who underwent coronary angiography and follow-up for 42 months. 1. We divided the patients into two groups according to whether they had G3I on admission, compared the differences in examination data and endpoint events between these two groups. 2. Group patients according to whether the endpoint events happened in hospital, at 12 and 42 months, compare whether there is a difference in fQRS-T angle at the same time point, and find out the predictive cutoff value of all-cause death. 3. Combined G3I and fQRS-T angle together to enhance the predictive value. RESULTS G3I and fQRS-T angle are both independent risk factors for all-cause death in STEMI patients within 12 months (G3I P = 0.014, fQRS-T angle P < 0.001) and within 42 months (P < 0.001). The cutoff values of fQRS-T angle for predicting all-cause death are 66.5° at 12 months and 90.5° at 42 months. When G3I and fQRS-T angle are combined used to predict the mortality, the specificity is significantly improved, but the sensitivity decreased. CONCLUSIONS G3I and fQRS-T angles are valuable in the prognostic assessment of STEMI patients, especially when combined. These findings help clinicians to identify high-risk patients early for more aggressive treatment.
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Affiliation(s)
- Xiaorong Han
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Zhongbo Chen
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Yinghui Wang
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Jin Zhang
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Ying Zhang
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Qiang Su
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Zhenghu Pan
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Jian Sun
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Yonggang Wang
- Department of Cardiovascular Center, Jilin University First Hospital, China.
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Tiller C, Reindl M, Reinstadler SJ, Klug G. The classical 12‑lead ECG: Much more to offer than just a diagnosis in STEMI? Int J Cardiol 2021; 349:29-30. [PMID: 34864076 DOI: 10.1016/j.ijcard.2021.11.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Christina Tiller
- University Clinic for Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Austria
| | - Martin Reindl
- University Clinic for Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Austria
| | - Sebastian J Reinstadler
- University Clinic for Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Austria
| | - Gert Klug
- University Clinic for Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Austria.
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Prasitlumkum N, Sirinvaravong N, Limpruttidham N, Rattanawong P, Tom E, Kanitsoraphan C, Chongsathidkiet P, Boondarikpornpant T. Terminal QRS Distortion in ST Elevation Myocardial Infarction as a Prediction of Mortality: Systematic Review and Meta-Analysis. ACTA CARDIOLOGICA SINICA 2019; 35:445-458. [PMID: 31571793 DOI: 10.6515/acs.201909_35(5).20180909a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Terminal QRS distortion reflects advanced stage and large myocardial infarction predisposing the heart to adverse outcomes. Recent studies suggest that terminal QRS distortion is associated with morbidity and mortality in ST elevation myocardial infarction (STEMI). However, a systematic review and meta-analysis of the literature have not been done. Objective We assessed the association between terminal QRS distortion in patients with STEMI and mortality by a systematic review of the literature and a meta-analysis. Methods We comprehensively searched the databases of MEDLINE and EMBASE from inception to September 2017. Included studies were published prospective or retrospective cohort studies that compared all-cause mortality in subjects with STEMI with QRS distortion versus those without QRS distortion. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. Results Fifteen studies from January 1993 to May 2015 were included in this meta-analysis involving 7,479 subjects with STEMI (2,906 QRS distortion and 4,573 non-QRS distortion). QRS distortion was associated with increased mortality (pooled risk ratio = 1.81, 95% confidence interval: 1.37-2.40, p < 0.000, I2 = 41.6%). Considering the introduction of clopidogrel in 2004, we performed subgroup analyses before and after 2004, and the associated with higher mortality was still present (before 2004, RR 1.75, 95% CI 1.08-2.82, p = 0.022, I2 = 66.1%; after 2004, RR 1.96, 95% CI 1.44-2.65, p < 0.001, I2 = 0%). Conclusions Terminal QRS distortion increased all-cause mortality by 81%. Our study suggests that terminal QRS distortion is an important tool to assess the risk in patients with STEMI.
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Affiliation(s)
| | | | | | - Pattara Rattanawong
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI.,Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Elysse Tom
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI
| | | | - Pakawat Chongsathidkiet
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
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Localization of the culprit artery in inferior myocardial infarction: Influence of the point of measurement of ST segment. J Electrocardiol 2019; 53:8-12. [DOI: 10.1016/j.jelectrocard.2018.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/03/2018] [Accepted: 12/13/2018] [Indexed: 11/23/2022]
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Koivula K, Eskola M, Viikilä J, Lilleberg J, Huhtala H, Birnbaum Y, Nikus K. Outcome of all-comers with STEMI based on the grade of ischemia in the presenting ECG. J Electrocardiol 2018; 51:598-606. [DOI: 10.1016/j.jelectrocard.2018.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/29/2018] [Indexed: 11/17/2022]
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Valle-Caballero MJ, Fernández-Jiménez R, Díaz-Munoz R, Mateos A, Rodríguez-Álvarez M, Iglesias-Vázquez JA, Saborido C, Navarro C, Dominguez ML, Gorjón L, Fontoira JC, Fuster V, García-Rubira JC, Ibanez B. QRS distortion in pre-reperfusion electrocardiogram is a bedside predictor of large myocardium at risk and infarct size (a METOCARD-CNIC trial substudy). Int J Cardiol 2015; 202:666-73. [PMID: 26453814 DOI: 10.1016/j.ijcard.2015.09.117] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/24/2015] [Accepted: 09/28/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND QRS distortion is an electrocardiographic (ECG) sign of severe ongoing ischemia in the setting of ST-segment elevation acute myocardial infarction (STEMI). We sought to evaluate the association between the degree of QRS distortion and myocardium at risk and final infarct size, measured by cardiac magnetic resonance (CMR). METHODS A total of 174 patients with a first anterior STEMI reperfused by primary angioplasty were prospectively recruited. Pre-reperfusion ECG was used to divide the study population into three groups according to the absence of QRS distortion (D0) or its presence in a single lead (D1) or in 2 or more contiguous leads (D2+). Myocardium at risk and infarct size were determined by CMR one week after STEMI. Multiple regression analysis was used to study the association of QRS distortion with myocardium at risk and infarct size, with adjustment for relevant clinical and ECG variables. RESULTS 101 patients (58%) were in group D0, 30 (17%) in group D1, and 43 (25%) in group D2+. Compared with group D0, presence of QRS distortion (groups D2+ and D1) was associated with a significantly adjusted larger extent of myocardium at risk (group D2+: absolute increase 10.4%, 95% CI 6.1-14.8%, p<0.001; group D1: absolute increase 3.3%, 95% CI 1.3-7.9%, p=0.157) and larger infarct size (group D2+: absolute increase 10.1%, 95% CI 5.5-14.7%, p<0.001; group D1: absolute increase 4.9%, 95% CI 0.08-9.8%, p=0.046). CONCLUSIONS Distortion in the terminal portion of the QRS complex on pre-reperfusion ECG in two or more leads is independently associated with larger myocardium at risk and infarct size in the setting of primary angioplasty-reperfused anterior STEMI. QRS distortion in only one lead is independently associated with larger infarct size in this setting. Our findings suggest that QRS distortion analysis could be included in risk-stratification of patients presenting with anterior STEMI.
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Affiliation(s)
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Raquel Díaz-Munoz
- Consultorio de Quijorna (Centro de Salud de Villanueva de la Cañada), Spain
| | - Alonso Mateos
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Servicio de Urgencia Médica de Madrid (SUMMA112), Spain; Universidad Francisco de Vitoria, Madrid, Spain
| | | | | | - Carmen Saborido
- Complejo Hospitalario Universitario de Vigo-Meixoeiro, Pontevedra, Spain
| | | | | | - Luisa Gorjón
- Servicio de Emergencia Médica 061 de Galicia, Spain
| | | | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, USA
| | | | - Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; IIS, Fundación Jiménez Díaz Hospital, Madrid, Spain.
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Abstract
Shortly following an occlusion of an epicardial coronary artery, changes in the surface electrocardiogram (ECG) can be detected. Initially, T waves in leads with their positive poles facing the ischemic zone become positive, tall and symmetrical. Later, ST segment elevation (STE) becomes apparent. If ischemia continues, changes in the terminal portion of the QRS may also be detected. The changes in the terminal portion of the QRS are believed to be caused by prolongation of the electrical conduction in the ischemic zone and reflect severe ischemia due to lack of protection by preconditioning or collateral circulation. Several groups have shown that patients with the QRS changes of grade 3 ischemia have higher mortality, higher incidence of reinfarction and heart failure than patients presenting with only the T and ST changes of grade 2 ischemia, despite equal success in recanalizing the epicardial coronary artery by either thrombolytic therapy or primary percutaneous coronary intervention. Grade 3 ischemia is associated with more rapid progression of necrosis and larger final infarct size. Further studies are needed to better understand the underlying mechanisms that determine the severity of ischemia and how we should use this method based on the standard 12 lead ECG to implement clinical therapeutic decisions.
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Fernandez-Jimenez R, Vivas D, García-Rubira JC, Fernandez-Ortiz A, Balbacid E, Kallmeyer A, Macaya C. Profound myocardial ischemia associated to occlusion of the right coronary artery. Int J Cardiol 2011; 149:e123-4. [DOI: 10.1016/j.ijcard.2009.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Accepted: 06/09/2009] [Indexed: 10/20/2022]
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