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Dehghani P, Zahedi A, Hassanzadeh M, Alavi SH, Jannati M, Mehdipour Namdar Z, Aslani A. Significance of ST-Segment elevation in V4R lead in patients with anterior myocardial infarction. Ann Noninvasive Electrocardiol 2021; 26:e12866. [PMID: 34089286 PMCID: PMC8411741 DOI: 10.1111/anec.12866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/06/2021] [Accepted: 05/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background There is some evidence of the association between ST‐segment elevation in the V4R chest lead and the likelihood of anterior wall myocardial infarction; however, the link of this phenomenon with the location and the severity of the coronary involvements in such patients remains uncertain. We aimed to investigate the ST‐segment elevation in V4R leads in patients with anterior myocardial infarction and also its effect on prognosis as well as the detection and prediction of the location of arterial stenosis in coronary angiography. Methods Data collection was performed by reviewing the hospital recorded files of 195 patients’ suspicion of acute myocardial infarction who have been referred within 2 h of the onset of cardiac symptoms. The patients were then categorized into two groups with and without ST elevation in the V4R chest lead. Results Comparing two groups showed a significantly higher rate of concurrent ST‐segment elevation in V1 lead in those with ST‐segment elevation in V4R. Echocardiography on the day after anterior myocardial infarction showed LVEF <40% in 74% and 35.2% of patients with and without ST‐segment elevation in V4R, respectively, indicating a significant difference. The lesions on proximal LAD were more common in the group with ST‐segment elevation in V4R. Conclusion Our study emphasized a high likelihood of ST‐segment elevation in V4R lead concurrently with ST‐elevation in V1 lead. Also, the appearance of ST‐segment elevation in V4R lead can be accompanied with a lower LVEF, myocardial infarct size, involvement of proximal part of LAD, and Wrap around LAD.
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Affiliation(s)
| | - Ali Zahedi
- Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | | | | | - Amir Aslani
- Shiraz University of Medical Sciences, Shiraz, Iran
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Pascale P, Pavon AG, Bogaert J, Bennett J, Monney P, Muller O, Schwitter J, Masci PG. Acute chest pain with ST-segment elevation in lead V1-V3: when you hear hoofbeats, also look for zebras. Clin Res Cardiol 2021; 110:1516-1522. [PMID: 33547960 DOI: 10.1007/s00392-021-01803-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/06/2021] [Indexed: 11/24/2022]
Abstract
ST-segment elevation (STE) in the anterior precordial leads is the hallmark of anterior myocardial infarction. In rare cases, this ECG pattern may be due to isolated infarction of the right ventricle since leads V1-V3 directly overlie the right ventricular free wall. Herein, we aimed to provide clues to recognize and understand this diagnostic pitfall through a series of 4 patients presenting with STE in the anterior leads.
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Affiliation(s)
- Patrizio Pascale
- Cardiology Division, Heart and Vessels Department, Lausanne University Hospital, BH 10-982, Rue de Bugnon 46, 1011, Lausanne, Switzerland.
| | - Anna Giulia Pavon
- Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Lausanne, Switzerland
| | - Jan Bogaert
- Gasthuisberg University Hospitals, Leuven, Belgium
| | | | - Pierre Monney
- Cardiology Division, Heart and Vessels Department, Lausanne University Hospital, BH 10-982, Rue de Bugnon 46, 1011, Lausanne, Switzerland.,Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Cardiology Division, Heart and Vessels Department, Lausanne University Hospital, BH 10-982, Rue de Bugnon 46, 1011, Lausanne, Switzerland
| | - Juerg Schwitter
- Cardiology Division, Heart and Vessels Department, Lausanne University Hospital, BH 10-982, Rue de Bugnon 46, 1011, Lausanne, Switzerland.,Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Lausanne, Switzerland
| | - Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital Campus, Westminster Bridge Road, London, UK
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Keskin M, Uzun AO, Börklü EB, Hayıroğlu Mİ, Türkkan C, Tekkeşin Aİ, Kozan Ö. The prognostic significance of early and late right precordial lead (V 4 R) ST-segment elevation in patients with acute anterior myocardial infarction. Ann Noninvasive Electrocardiol 2017; 23:e12513. [PMID: 29030902 DOI: 10.1111/anec.12513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/13/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The predictive significance of ST-segment elevation (STE) in lead V4 R in patients with anterior ST-segment elevation myocardial infarction (STEMI) has not been well-understood. In this study, we evaluated the prognostic value of early and late STE in lead V4 R in patients with anterior STEMI. METHODS A total 451 patients with anterior STEMI who treated with primary percutaneous coronary intervention (PPCI) were prospectively enrolled in this study. All patients were classified according to presence of STE (>1 mm) in lead V4 R at admission and/or 60 min after PPCI. Based on this classification, all patients were divided into three subgroups as no V4 R STE (Group 1), early but not late V4 R STE (Group 2) and late V4 R STE (Group 3). RESULTS In-hospital mortality had higher rates at group 2 and 3 and that had 2.1 and 4.1-times higher mortality than group 1. Late V4 R STE remained as an independent risk factor for cardiogenic shock (odds ratio [OR] 2.6; 95% confidence interval [CI] 1.9-4.3; p < .001) and in-hospital mortality (OR 2.3; 95% CI 1.8-4.1; p < .001). The 12-month overall survival for group 1, 2, and 3 were 91.1%, 82.4%, and 71.4% respectively. However, the long-term mortality also had the higher rate at group 3; late V4 R STE did not remain as an independent risk factor for long-term mortality (OR 1.5; 95% CI 0.8-4.1; p: .159). CONCLUSION Late V4 R STE in patients with anterior STEMI is strongly associated with poor prognosis. The record of late V4 R in patients with anterior STEMI has an important prognostic value.
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Affiliation(s)
- Muhammed Keskin
- Department of Cardiology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Okan Uzun
- Department of Cardiology, Dortyol State Hospital, Hatay, Turkey
| | - Edibe Betül Börklü
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mert İlker Hayıroğlu
- Department of Cardiology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Ceyhan Türkkan
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet İlker Tekkeşin
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ömer Kozan
- Department of Cardiology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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Ghaffari S, Taban Sadeghi M, Sayyadi MH. The association of right coronary artery conus branch size and course with ST segment elevation of right precordial leads and clinical outcome of acute anterior myocardial infarction. J Cardiovasc Thorac Res 2017; 9:49-53. [PMID: 28451088 PMCID: PMC5402027 DOI: 10.15171/jcvtr.2017.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/11/2017] [Indexed: 12/25/2022] Open
Abstract
Introduction: Coronary artery disease is the leading cause of death worldwide and electrocardiogram (ECG) is a reliable diagnostic tool to determine a myocardial infarction. The present study tried to compare the relationship between the ECG findings and angiographic findings in patients with acute anterior myocardial infarction. Methods: Seventy-four patients with acute anterior ST elevation myocardial infarction (Ant- STEMI) presenting to the emergency room in the first 12 hours after the onset of symptoms were studied. Upon admission, a full 14-lead ECG (including leads V3R and V4R) were performed. Angiographic and ECG findings, as well as clinical outcome were compared between two groups. The statistical tests including Chi-square and independent t-test were used for data analysis. Results: Small conus branch was seen in 52 (70.3%) and large conus in 22 ( 29.7%) patients. STE in right-sided leads and heart failure were significantly higher in small conus branch group versus large conus branch (88.6% vs 11.4%, P < 0.001 and 34.6% vs 9.1%, P = 0.02 respectively). There was no significant difference in mortality rate between the two groups (5.8% in small conous group vs 0% in large conus group, P = 0.55). There was a significant difference in major adverse cardiac events (MACE) between the two groups (51.9% in small conous group vs 18.2% in large conus group, P = 0.01). Conclusion: In patients with anterior MI, small conus branch was associated with higher rate of major adverse cardiac events mostly because of increased rate of acute heart failure.
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Affiliation(s)
- Samad Ghaffari
- Cardiovascular Research Center, Madani Heart Hospital, Tabriz University of Medicine, Tabriz, Iran
| | | | - Mohammad Hossein Sayyadi
- Cardiovascular Research Center, Madani Heart Hospital, Tabriz University of Medicine, Tabriz, Iran
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Pourafkari L, Joudi S, Ghaffari S, Tajlil A, Kazemi B, Nader ND. ST-Segment Elevation in the Right Precordial Leads in Patients with Acute Anterior Myocardial Infarction. Balkan Med J 2016; 33:58-63. [PMID: 26966619 DOI: 10.5152/balkanmedj.2015.15975] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 06/15/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Elevation of ST segment in leads V3R/ V4R, which is commonly encountered in right ventricular myocardial infarction, may also occur in patients with anterior ST elevation myocardial infarction (STEMI). However, the clinical impact of this finding in the setting of anterior myocardial infarction is not well understood. AIMS We aimed to investigate the prognostic value of ST segment elevation in leads V3R/V4R in patients with first acute anterior myocardial infarction. STUDY DESIGN Prospective cohort study. METHODS Right precordial leads V3R/V4R were recorded in 111 patients admitted with first time anterior myocardial infarction. Patients were allocated into two groups based on the presence or absence of ST elevation in leads V3R/V4R. Demographic, biochemical and echocardiographic data, as well as the angiographic information, were recorded. In-hospital and 3 month mortality, and major adverse cardiac events (MACE), death, heart failure and ventricular dysrhythmia were also compared. RESULTS ST elevation in lead V3R or V4R was present in 72 out of 111 patients (64.9%). Involvement of the proximal part of the left anterior descending (LAD) artery was not different in the two groups (44.4% of patients with elevation vs. 53.8% of patients without elevation, p=0.22). Post-myocardial infarction complications, mortality and major adverse cardiac events were similar in the two groups. Left ventricular ejection fraction (LVEF) was significantly lower in patients with ST elevation in V3R/V4R (35 %±8 vs. 38 %±8, p=0.02). Twenty three out of 111 patients (20.7%) developed heart failure, which was similar in the two groups [16 (22.2%) of patients with ST elevation vs. 7 (17.9%) of patients without ST elevation, p=0.39]. CONCLUSION Although ST elevation in V3R/V4R can be present in patients with left anterior descending artery occlusion, it does not seem to predict the prognosis. Lower left ventricular ejection fraction in this group may play a role in the long-term prognosis; however, this issue needs further investigation.
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Affiliation(s)
- Leili Pourafkari
- Department of Cardiology, Tabriz University of Medical Sciences Cardiovascular Research Center, Tabriz, Iran
| | - Saeid Joudi
- Department of Cardiology, Tabriz University of Medical Sciences Cardiovascular Research Center, Tabriz, Iran
| | - Samad Ghaffari
- Department of Cardiology, Tabriz University of Medical Sciences Cardiovascular Research Center, Tabriz, Iran
| | - Arezou Tajlil
- Department of Cardiology, Tabriz University of Medical Sciences Cardiovascular Research Center, Tabriz, Iran
| | - Babak Kazemi
- Department of Cardiology, Tabriz University of Medical Sciences Cardiovascular Research Center, Tabriz, Iran
| | - Nader D Nader
- Department of Anesthesiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, New York, USA
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Tusun E, Uluganyan M, Ugur M, Karaca G, Osman F, Koroglu B, Murat A, Ekmekci A, Uyarel H, Sahin O, Eren M, Bolca O. ST-segment elevation of right precordial lead (V4 R) is associated with multivessel disease and increased in-hospital mortality in acute anterior myocardial infarction patients. Ann Noninvasive Electrocardiol 2014; 20:362-7. [PMID: 25209301 DOI: 10.1111/anec.12199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND ST segment elevation of chest lead V4 R is associated with worse prognosis in acute inferior ST-elevation myocardial infarction (STEMI). This study tried to determine the relationship between ST elevation in the right precordial lead V4 R and acute anterior STEMI. METHODS Prospective study of 144 consecutive anterior STEMI patients: all had 15-lead ECG recordings (12 conventional leads and V3 R-V5 R) obtained. Patients were classified into two groups on the basis of presence (Group I, 50 patients) or absence (Group II, 94 patients) of ST-segment elevation ≥0.5 mm in lead V4 R. RESULTS Multivessel involvement was significantly higher in Group I compared with Group II (54% and 23% respectively, P < 0.001). Major adverse cardiac events and in-hospital mortality was also significantly higher for those in Group I (P < 0.02 for both). A significant correlation was found between in-hospital mortality and those in Group I (P = 0.03, OR: 6.27, CI: 1.22-32.3). There was an independent relationship between in-hospital mortality and V4 R-ST elevation (P = 0.03, OR: 11.64, CI: 1.3-27.4). CONCLUSION ST segment elevation in chest lead V4 R is associated with multivessel disease and increased in-hospital mortality in patients with anterior STEMI that had undergone primary percutaneous coronary intervention to the left anterior descending artery.
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Affiliation(s)
- Eyyup Tusun
- Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Mahmut Uluganyan
- Clinic of Cardiology, Kadirli Government Hospital, Osmaniye, Turkey
| | - Murat Ugur
- Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Gurkan Karaca
- Clinic of Cardiology, Osmancik Government Hospital, Corum, Turkey
| | - Faizel Osman
- Department of Cardiology, University Hospital Coventry, Coventry, United Kingdom
| | - Bayram Koroglu
- Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Murat
- Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Ekmekci
- Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Hüseyin Uyarel
- Clinic of Cardiology, Bezmialem University Hospital, Istanbul, Turkey
| | - Osman Sahin
- Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Eren
- Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Osman Bolca
- Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
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Zecchin M, Proclemer A, Magnani S, Vitali-Serdoz L, Facchin D, Muser D, Nordio A, Barbati G, Puggia I, Sinagra G, Proclemer A. Long-term outcome of 'super-responder' patients to cardiac resynchronization therapy. Europace 2013; 16:363-71. [PMID: 24189477 DOI: 10.1093/europace/eut339] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AIMS To evaluate the long-term changes of clinical and echocardiographic parameters, the incidence of cardiac events and parameters associated with late cardiac events in 'super-responders' to cardiac resynchronization therapy (CRT) with [CRT defibrillator (CRT-D)] or without defibrillator back-up. METHODS AND RESULTS In all consecutive patients treated with CRT in two Italian centres (Trieste and Udine) with left ventricular ejection fraction (LVEF) ≤0.35 at implantation (Timp) and LVEF > 0.50 1 and/or 2 years (Tnorm) after implantation, the long-term outcome and the evolution of echocardiographic parameters were assessed; factors associated with a higher risk of cardiac events, defined as hospitalization or death for heart failure (HF), sudden death, or CRT-D appropriate interventions, were also analysed. Among the 259 patients evaluated, 62 (24%) had LVEF ≥ 0.50 at Tnorm (n = 44 with at 1 year, n = 18 at 2 years). During a mean follow-up of 68 ± 30 months, one cardiac death (for HF) and eight cardiovascular events (two hospitalization for HF and six appropriate CRT-D interventions) occurred. At the last echo evaluation (Tfup) performed 51 ± 26 months after Timp, LVEF was <0.50 in five patients (>0.45 in four of them). At univariable analysis, only LV end-systolic volume evaluated at Tfup was associated with a higher risk of cardiac events during follow-up. CONCLUSION In 'super-responders' to CRT long-term outcome is excellent. However, cardiac events, mainly CRT-D appropriate interventions, can occur despite the persistence of LVEF > 0.50. Early identification of these patients is still an unsolved issue.
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Affiliation(s)
- Massimo Zecchin
- Cardiovascular Department, University and 'Ospedali Riuniti di Trieste' Hospital, Via Valdoni, 7, 34129 Trieste, Italy
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Ayhan E, Uyarel H, Isık T, Ergelen M, Ghannadian B. The indicators of high risk on admission electrocardiography in patients with anterior wall ST-elevation myocardial infarction. Int J Cardiol 2013; 164:376-7. [DOI: 10.1016/j.ijcard.2012.08.006] [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: 07/01/2012] [Accepted: 08/19/2012] [Indexed: 11/28/2022]
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