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Du X, Zhang Y. Transient J wave-like ST-segment elevation in intracerebral hemorrhage: a case report. BMC Cardiovasc Disord 2022; 22:255. [PMID: 35672678 PMCID: PMC9172060 DOI: 10.1186/s12872-022-02696-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background Certain cerebrovascular events can induce electrocardiography (ECG) abnormalities and cardiac dysfunction. The most frequent patterns reported are nonspecific ST-T change, inverted or broad T wave, prolongation of QT interval as well as ST-segment depression or elevation. Here we present a case of intracerebral hemorrhage (ICH) with transient J wave-like ST-segment elevation accompanied by myocardial lesion. Case presentation A 58-year-old woman was admitted to our hospital and diagnosed with right basal ganglia region cerebral hemorrhage. The ECG recorded on the second hospital day showed transient J wave-like ST-segment elevation accompanied by increased myocardial troponin I and myocardial enzyme. Conclusions The J wave-like ST-segment elevation may be not a specific ECG signs for primary ischemic heart diseases as it also could be found in ICH patients. We believe that the follow-up ECGs can be used in conjunction with repeated myocardial enzyme analysis and echocardiography to differentiate ICH-ralated J wave-like ST-segment elevation from acute myocardial infarction (AMI), thus avoiding unnecessary cardiac catheterization.
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Affiliation(s)
- Xing Du
- Department of Electrophysiology, Yijishan Hospital of Wannan Medical College, 2 Zheshan Road, Wuhu, China
| | - Yongjun Zhang
- Department of Electrophysiology, Yijishan Hospital of Wannan Medical College, 2 Zheshan Road, Wuhu, China.
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2
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The prognostic value of the combined use of QRS distortion and fragmented QRS in patients with acute STEMI undergoing primary percutaneous coronary intervention. J Electrocardiol 2018; 51:210-217. [DOI: 10.1016/j.jelectrocard.2017.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Indexed: 11/20/2022]
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Dr. Galen Wagner (1939-2016) as an Academic Writer: An Overview of his Peer-reviewed Scientific Publications. J Electrocardiol 2017; 50:47-73. [DOI: 10.1016/j.jelectrocard.2016.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Weaver JC, Rees D, Prasan AM, Ramsay DD, Binnekamp MF, McCrohon JA. Grade 3 ischemia on the admission electrocardiogram is associated with severe microvascular injury on cardiac magnetic resonance imaging after ST elevation myocardial infarction. J Electrocardiol 2011; 44:49-57. [DOI: 10.1016/j.jelectrocard.2010.09.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Indexed: 10/18/2022]
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MYOJO TAKUYA, SATO NOBUYUKI, MATSUKI MOTOKI, TANIGUCHI OSAMU, NAKAMURA HIDEKI, HASEBE NAOYUKI. An Acute Myocardial Infarction Case that Survived An Out-of-Hospital Cardiac Arrest in Which Prominent Ischemic J Waves Were Documented. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 35:e27-30. [DOI: 10.1111/j.1540-8159.2010.02874.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tomcsányi J, Nényei Z, Sármán B, Arabadzisz H, Zsoldos A, Frész T. A new ECG marker of anterior acute myocardial infarction. Orv Hetil 2010; 151:387-9. [DOI: 10.1556/oh.2010.28807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A szerzők az akut anterior myocardialis infarctus egy új EKG-formáját ismertetik. Amíg proximalis LAD-occlusio esetén általában kiterjedt mellsőfali ST-eleváció látható, ezen új formában a hiperakut pozitív T-hullámokat J-pont-süllyedés és aszcendáló ST-depresszió vagy digoxinhatáshoz hasonló sajka-ST-depresszió kíséri. Ezért könnyen elnézhető, ami nagy szívizomvesztéssel járó infarctust vagy akár a beteg halálát is okozhatja. Ezért ezen esetekben a beteget – függetlenül attól, hogy nincs ST-elevációja – mielőbb reperfúziós terépiában kell részesíteni.
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Affiliation(s)
- János Tomcsányi
- 1 Budai Irgalmasrendi Kórház Kardiológia Osztály Budapest Árpád fejedelem u. 7. 1023
| | - Zoltán Nényei
- 1 Budai Irgalmasrendi Kórház Kardiológia Osztály Budapest Árpád fejedelem u. 7. 1023
| | - Balázs Sármán
- 1 Budai Irgalmasrendi Kórház Kardiológia Osztály Budapest Árpád fejedelem u. 7. 1023
| | - Hrisula Arabadzisz
- 1 Budai Irgalmasrendi Kórház Kardiológia Osztály Budapest Árpád fejedelem u. 7. 1023
| | - András Zsoldos
- 1 Budai Irgalmasrendi Kórház Kardiológia Osztály Budapest Árpád fejedelem u. 7. 1023
| | - Tamás Frész
- 1 Budai Irgalmasrendi Kórház Kardiológia Osztály Budapest Árpád fejedelem u. 7. 1023
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7
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Ringborn M, Pettersson J, Persson E, Warren SG, Platonov P, Pahlm O, Wagner GS. Comparison of high-frequency QRS components and ST-segment elevation to detect and quantify acute myocardial ischemia. J Electrocardiol 2010; 43:113-20. [DOI: 10.1016/j.jelectrocard.2009.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Indexed: 11/28/2022]
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Ischemic J wave: Novel risk marker for ventricular fibrillation? Heart Rhythm 2009; 6:829-35. [DOI: 10.1016/j.hrthm.2009.02.036] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 02/21/2009] [Indexed: 11/24/2022]
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Celik T, Yuksel UC, Iyisoy A, Kilic S, Kardesoglu E, Bugan B, Isik E. The impact of preinfarction angina on electrocardiographic ischemia grades in patients with acute myocardial infarction treated with primary percutaneous coronary intervention. Ann Noninvasive Electrocardiol 2008; 13:278-86. [PMID: 18713329 DOI: 10.1111/j.1542-474x.2008.00232.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Grade 3 ischemia (G3I) is defined as ST elevation with distortion of the terminal portion of the QRS (emergence of the J point > 50% of the R wave in leads with qR configuration, or disappearance of the S wave in leads with an Rs configuration). Patients with G3I on the presenting electrocardiogram (ECG) had worse prognosis than the patients with lesser (grade 2-G2I) ischemia. The aim of this study is to examine the effects of preinfarct angina (PIA) on electrocardiographic ischemia grades. METHODS One hundred forty-eight consecutive patients with ST-segment myocardial infarction (STEMI) were included in this study. All patients underwent primary percutaneous coronary intervention. The admission ECGs was analyzed retrospectively for electrocardiographic ischemia grades and compared with the presence of PIA. RESULTS Study population consisted of 110 patients with G2I (88 men, mean age = 63 +/- 6 years) and 38 patients with G3I (32 men, mean age = 61 +/- 8 years). Baseline characteristics of the groups were the same except for patients with G3I had significantly longer pain to balloon time and higher admission creatine kinase MB isoenzyme (CK-MB) levels. Tissue myocardial perfusion grade (TMPG) was better in patients with G2I. While 18 patients (47%) with G3I had PIA, 81 patients (70%) with G2I had PIA (P = 0.005). Although pain to balloon time and admission CK-MB were independent predictor of worse electrocardiographic ischemia grade (OR 1.69, 95% CI 1.09-2.62; P = 0.01; OR 1.01, 1.00-1.02, P = 0.04), PIA and left ventricular ejection time (LVEF) were independent predictors of better electrocardiographic ischemia grade (OR 0.4, 95% CI 0.17-0.90; P = 0.02, OR 0.92, 95% CI 0.85-0.99; P = 0.03, respectively) in multivariate logistic regression analysis. CONCLUSION PIA is one of the most important clinical predictors of better ischemia grades especially when combined with the pain to balloon time, LVEF, and admission CK-MB levels in patients with STEMI. This study provided another evidence for the protective effects of PIA.
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Affiliation(s)
- Turgay Celik
- Gulhane Military Medical Academy, School of Medicine, Department of Cardiology, Etlik, Ankara, Turkey.
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Weston P, Johanson P, Schwartz LM, Maynard C, Jennings RB, Wagner GS. The value of both ST-segment and QRS complex changes during acute coronary occlusion for prediction of reperfusion-induced myocardial salvage in a canine model. J Electrocardiol 2006; 40:18-25. [PMID: 17069840 DOI: 10.1016/j.jelectrocard.2006.09.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Analysis of ST-segment elevation for assessment of patients with suspected acute coronary occlusion is in widespread use for diagnostic and prognostic purposes. In this study, changes in the QRS complex also were analyzed to determine if these changes that are seldom used clinically can provide additional prognostic information. An acute coronary occlusion canine model, in which direct measurements of myocardial salvage were made, was used to assess whether ST-segment and QRS complex changes during coronary occlusion yielded independent estimates of the amount of salvage provided by reperfusion with arterial blood. METHODS AND RESULTS Continuous electrocardiographic recordings were obtained from 14 study dogs undergoing a 90-minute period of coronary artery occlusion in which the severity of the ischemia during the occlusion was estimated at 10 and 45 minutes by microsphere injections. After 3 hours of reperfusion, the myocardium at risk and postmortem infarct size was measured. Myocardial salvage correlated inversely with both ST-segment elevation (r = -0.85; P < .0001), and QRS complex prolongation (r = -0.72; P = .003). When dogs were paired so that they had equal amounts of ST elevation but differed with respect to the presence of QRS prolongation, less myocardial salvage was found in those with QRS prolongation. The independent value of QRS prolongation was supported further by the observation that presence of QRS prolongation resulted in a loss of the highly significant correlation between ST elevation and salvage (r = -0.60; P = .2). CONCLUSIONS High magnitudes of ST elevation are correlated significantly with less myocardial salvage. Moreover, for a given magnitude of ST elevation, the presence of concurrent QRS prolongation is associated with even less myocardial salvage.
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Abstract
The ECG is an essential part of the initial evaluation of patients who have chest pain, especially in the immediate decision-making process in patients who have ST-elevation myocardial infarction. This article reviews and summarizes the current information that can be obtained from the admission ECG in patients who have ST-elevation acute myocardial infarction, with an emphasis on: (1) prediction of final infarct size, (2) estimation of prognosis, and (3) the correlations between various ECG patterns and the localization of the infarct and the underlying coronary anatomy.
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Affiliation(s)
- Shaul Atar
- Division of Cardiology, University of Texas Medical Branch, 5.106 John Sealy Annex, 301 University Boulevard, Galveston, TX 77555, USA
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Sejersten M, Birnbaum Y, Ripa RS, Maynard C, Wagner GS, Clemmensen P. Influences of electrocardiographic ischaemia grades and symptom duration on outcomes in patients with acute myocardial infarction treated with thrombolysis versus primary percutaneous coronary intervention: results from the DANAMI-2 trial. Heart 2006; 92:1577-82. [PMID: 16740918 PMCID: PMC1861241 DOI: 10.1136/hrt.2005.085639] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine whether ischaemia grade (GI) on the presenting ECG and duration of symptoms can identify subgroups of patients who would derive more benefit than the general population of patients with ST segment elevation acute myocardium infarction (STEMI) from primary percutaneous coronary intervention (pPCI) over thrombolytic treatment (TT) in reducing mortality or reinfarction. METHODS 1319 DANAMI-2 (Danish trial in Acute Myocardial Infarction-2) patients were classified as having grade 2 ischaemia (GI2; ST segment elevation without terminal QRS distortion) or grade 3 ischaemia (GI3; ST segment elevation with terminal QRS distortion in > or = 2 adjacent leads), and were divided into early and late groups split by the median time (3 h) from symptom onset to treatment. Outcomes were 30-day mortality and reinfarction. RESULTS Mortality was significantly higher for GI3 than for GI2 (9.7% v 4.8%, p < 0.001) and doubled for patients presenting late (GI2: 6.0% v 3.3%, p = 0.01; GI3: 12.5% v 4.7%, p = 0.05). Overall mortality did not differ significantly between pPCI and TT; however, a 5.5% absolute mortality reduction was seen in GI3 treated early with pPCI (1.4% v 6.9%, p = 0.10). Reinfarction rate was particularly high among GI3 patients presenting late and treated with TT (12.2%). pPCI in such patients significantly reduced the rate of reinfarction (0%, p < 0.001). Logistic regression analysis showed that age (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.06 to 1.12, p < 0.001), prior angina (OR 2.56, 95% CI 1.44 to 4.54, p = 0.001), heart rate (OR 1.03, 95% CI 1.01 to 1.04, p = 0.001) and GI3 (OR 1.91, 95% CI 1.06 to 3.44, p = 0.031) were independently associated with mortality, whereas the sum of ST segment elevation was not. CONCLUSIONS GI3 is an independent predictor of mortality among patients with STEMI. Mortality increased significantly with symptom duration in both GI2 and GI3. pPCI may be especially beneficial for patients with GI3 presenting early, whereas patients with GI3 presenting late and treated with TT are at particular risk of reinfarction.
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Affiliation(s)
- M Sejersten
- Department of Cardiology B, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Barbagelata A, Di Carli MF, Califf RM, Garg J, Birnbaum Y, Grinfeld L, Gibbons RJ, Granger CB, Goodman SG, Wagner GS, Mahaffey KW. Electrocardiographic infarct size assessment after thrombolysis: insights from the Acute Myocardial Infarction STudy ADenosine (AMISTAD) trial. Am Heart J 2005; 150:659-65. [PMID: 16209961 DOI: 10.1016/j.ahj.2004.10.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2004] [Accepted: 10/13/2004] [Indexed: 11/15/2022]
Abstract
BACKGROUND Noninvasive methods are needed to evaluate reperfusion success in patients with acute myocardial infarction (MI). The AMISTAD trial was analyzed to compare MI size and myocardial salvage determined by electrocardiogram (ECG) with technetium Tc 99m sestamibi single-photon emission computerized tomography (SPECT) imaging. METHODS Of 236 patients enrolled in AMISTAD, 166 (70 %) with no ECG confounding factors and no prior MI were included in this analysis. Of these, group 1 (126 patients, 53%) had final infarct size (FIS) available by both ECG and SPECT. Group 2 (56 patients, 24%) had myocardium at risk, FIS, and salvage index (SI) assessed by both SPECT and ECG techniques. Aldrich/Clemmensen scores for myocardium at risk and the Selvester QRS score for final MI size were used. Salvage index was calculated as follows: SI = (myocardium at risk-FIS)/(myocardium at risk). RESULTS In group 1, FIS was 15% (6, 24) as measured by ECG and 11% (2, 27) as measured by SPECT. In the adenosine group, FIS was 12% (6, 21) and 11% (2, 22). In the placebo group, FIS was 16.5% (7.5, 24) and 11.5% (3.0, 38.5) by ECG and SPECT, respectively. The overall correlation between SPECT and ECG for FIS was 0.58 (P = .0001): 0.60 in the placebo group (P = .0001) and 0.54 (P = .0001) in the adenosine group. In group 2, myocardium at risk was 23% (17, 30) and 26% (10, 50) with ECG and SPECT, respectively (P = .0066). Final infarct size was 17% (6, 21) and 12% (1, 24) (P < .0001). The SI was 29% (-7, 57) and 46% (15, 79) with ECG and SPECT, respectively (P = .0510). CONCLUSIONS The ECG measurement of infarct size has a moderate relationship with SPECT infarct size measurements in the population with available assessments. This ECG algorithm must further be validated on clinical outcomes.
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Billgren T, Birnbaum Y, Sgarbossa EB, Sejersten M, Hill NE, Engblom H, Maynard C, Pahlm O, Wagner GS. Refinement and interobserver agreement for the electrocardiographic Sclarovsky-Birnbaum Ischemia Grading System. J Electrocardiol 2004; 37:149-56. [PMID: 15286927 DOI: 10.1016/j.jelectrocard.2004.02.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Electrocardiogram-derived grades of ischemia at the time of patient presentation with acute myocardial infarction have proved useful in predicting the salvageability by reperfusion therapy, final infarct size, severity of left ventricular dysfunction, and short- and long-term prognosis. SUBJECTS AND METHODS The Sclarovsky-Birnbaum Ischemia Grading System based on the relation between the acute appearances of the T wave, the ST segment, and the QRS complex was considered as a means of enhanced ECG analysis in this group of patients. The evaluation of a training population (n = 46) resulted in refinement of the published description of the Sclarovsky-Birnbaum Ischemia Grading System, and a test population (n = 50) was utilized for investigating the interobserver agreement among 5 observers in determining the grade of ischemia. RESULTS The agreement among the observers applying the "refined" Sclarovsky-Birnbaum Ischemia Grading System was 0.89. Complete agreement was found for the ECGs of 80% of the patients, and the most common reason for disagreement was the application of the terminal T-negativity criterion. CONCLUSIONS The refined Sclarovsky-Birnbaum Ischemia Grading System can be performed manually with low interobserver variability. It has potential for support of the acute myocardial infarction triage decision as an electrocardiographic method for evaluating the level of ischemic protection at the time of either pre-hospital or emergency-department presentation.
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Affiliation(s)
- Therese Billgren
- Departmentof Cardiology, Duke Clinical Research Institute, Durham, NC, USA
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Birnbaum Y, Drew BJ. The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis. Postgrad Med J 2003; 79:490-504. [PMID: 13679544 PMCID: PMC1742828 DOI: 10.1136/pmj.79.935.490] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The electrocardiogram is considered an essential part of the diagnosis and initial evaluation of patients with chest pain. This review summarises the information that can be obtained from the admission electrocardiogram in patients with ST elevation acute myocardial infarction, with emphasis on: (1) prediction of infarct size, (2) estimation of prognosis, and (3) the correlations between various electrocardiographic patterns and the localisation of the infarct and the underlying coronary anatomy.
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Affiliation(s)
- Y Birnbaum
- University of Texas Medical Branch, Galveston, Texas 77555-0553, USA.
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Birnbaum Y, Criger DA, Wagner GS, Strasberg B, Mager A, Gates K, Granger CB, Ross AM, Barbash GI. Prediction of the extent and severity of left ventricular dysfunction in anterior acute myocardial infarction by the admission electrocardiogram. Am Heart J 2001; 141:915-24. [PMID: 11376304 DOI: 10.1067/mhj.2001.115300] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The grade of ischemia, as detected by the relation between the QRS complex and ST segment on the admission electrocardiogram, is associated with larger infarct size and increased mortality rates in acute myocardial infarction. METHODS We assessed the correlation between left ventricular function and the admission electrocardiogram in 151 patients with first anterior acute myocardial infarction who received thrombolytic therapy and underwent cardiac catheterization at 90 minutes and before hospital discharge. The number of leads with ST elevation, sum of ST elevation, maximal Selvester score, and the presence of severe (grade 3) ischemia were determined in each electrocardiogram. Left ventricular ejection fraction, the number of chords with wall motion abnormalities, and the severity of dysfunction (SD/chord) were determined. RESULTS At 90 minutes, the 39 ischemia grade 3 patients had lower ejection fraction than the 112 grade 2 patients. Both at 90 minutes and at hospital discharge, the grade 3 group had more chords with wall motion abnormalities and more severe regional dysfunction (SD/chord). However, the number of leads with ST elevation, sum of ST elevation, and maximal Selvester score had no correlation with ejection fraction at 90 minutes and only mild correlation with the extent of dysfunction (number of chords) at 90 minutes. There was no correlation between either the number of leads with ST elevation or the sum of ST elevation and the severity of regional dysfunction. CONCLUSIONS The number of leads with ST elevation, sum of ST elevation, and maximal Selvester score had only mild correlation with the extent of myocardial dysfunction but not with the severity of dysfunction. Grade 3 ischemia is predictive of more extensive myocardial involvement and greater severity of regional dysfunction.
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Affiliation(s)
- Y Birnbaum
- Division of Cardiology, Rabin Medical Center, Petah-Tiqva, Israel.
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