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Muscogiuri G, Guaricci AI, Soldato N, Cau R, Saba L, Siena P, Tarsitano MG, Giannetta E, Sala D, Sganzerla P, Gatti M, Faletti R, Senatieri A, Chierchia G, Pontone G, Marra P, Rabbat MG, Sironi S. Multimodality Imaging of Sudden Cardiac Death and Acute Complications in Acute Coronary Syndrome. J Clin Med 2022; 11:jcm11195663. [PMID: 36233531 PMCID: PMC9573273 DOI: 10.3390/jcm11195663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/07/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022] Open
Abstract
Sudden cardiac death (SCD) is a potentially fatal event usually caused by a cardiac arrhythmia, which is often the result of coronary artery disease (CAD). Up to 80% of patients suffering from SCD have concomitant CAD. Arrhythmic complications may occur in patients with acute coronary syndrome (ACS) before admission, during revascularization procedures, and in hospital intensive care monitoring. In addition, about 20% of patients who survive cardiac arrest develop a transmural myocardial infarction (MI). Prevention of ACS can be evaluated in selected patients using cardiac computed tomography angiography (CCTA), while diagnosis can be depicted using electrocardiography (ECG), and complications can be evaluated with cardiac magnetic resonance (CMR) and echocardiography. CCTA can evaluate plaque, burden of disease, stenosis, and adverse plaque characteristics, in patients with chest pain. ECG and echocardiography are the first-line tests for ACS and are affordable and useful for diagnosis. CMR can evaluate function and the presence of complications after ACS, such as development of ventricular thrombus and presence of myocardial tissue characterization abnormalities that can be the substrate of ventricular arrhythmias.
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Affiliation(s)
- Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, Piazzale Brescia 20, 20149 Milan, Italy
- School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy
- Correspondence:
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Nicola Soldato
- University Cardiology Unit, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, 09124 Cagliari, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, 09124 Cagliari, Italy
| | - Paola Siena
- University Cardiology Unit, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Maria Grazia Tarsitano
- Department of Medical and Surgical Science, University Magna Grecia, 88100 Catanzaro, Italy
| | - Elisa Giannetta
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy
| | - Davide Sala
- Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
| | - Paolo Sganzerla
- Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
| | - Marco Gatti
- Radiology Unit, Department of Surgical Sciences, University of Turin, 10124 Turin, Italy
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, University of Turin, 10124 Turin, Italy
| | - Alberto Senatieri
- School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy
| | | | | | - Paolo Marra
- School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Mark G. Rabbat
- Division of Cardiology, Loyola University of Chicago, Chicago, IL 60611, USA
- Edward Hines Jr. VA Hospital, Hines, IL 60141, USA
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
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Nikus K, Birnbaum Y, Fiol-Sala M, Rankinen J, de Luna AB. Conduction Disorders in the Setting of Acute STEMI. Curr Cardiol Rev 2021; 17:41-49. [PMID: 32614749 PMCID: PMC8142368 DOI: 10.2174/1573403x16666200702121937] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 02/28/2020] [Accepted: 03/12/2020] [Indexed: 11/22/2022] Open
Abstract
ST-elevation myocardial (STEMI) is frequently associated with conduction disorders. Regional myocardial ischemia or injury may affect the cardiac conduction system at various locations, and neural reflexes or changes in the balance of the autonomous nervous system may be involved. Sinoatrial and atrioventricular blocks are more frequent in inferior than anterior STEMI, while new left anterior fascicular block and right bundle branch block indicate proximal occlusion of the left anterior descending coronary artery. New left bundle branch block is associated with multi-vessel disease. Most conduction disorders associated with STEMI are reversible with reperfusion therapy, but they may still impair prognosis because they indicate a large area at risk, extensive myocardial infarction or severe coronary artery disease. Acute STEMI recognition is possible in patients with a fascicular or right bundle branch block, but future studies need to define the cut-off values for ST depression in the leads V1-V3 in inferolateral MI and for ST elevation in the same leads in anterior STEMI. In the left bundle branch block, concordant ST elevation is a specific sign of acute coronary artery occlusion, but the ECG feature has low sensitivity.
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Affiliation(s)
- Kjell Nikus
- Address correspondence to this author at the Department of Cardiology, Heart Center, Tampere University Hospital, Ensitie 4, 33520 Tampere,
Finland; Tel: +358 50 5575 396; E-mail:
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ECG analysis in patients with acute coronary syndrome undergoing invasive management: rationale and design of the electrocardiography sub-study of the MATRIX trial. J Electrocardiol 2019; 57:44-54. [PMID: 31491602 DOI: 10.1016/j.jelectrocard.2019.08.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/18/2019] [Accepted: 08/27/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The twelve‑lead electrocardiogram (ECG) has become an essential tool for the diagnosis, risk stratification, and management of patients with acute coronary syndromes (ACS). However, several areas of residual controversies or gaps in evidence exist. Among them, P-wave abnormalities identifying atrial ischemia/infarction are largely neglected in clinical practice, and their diagnostic and prognostic implications remain elusive; the value of ECG to identify the culprit lesion has been investigated, but validated criteria indicating the presence of coronary occlusion in patients without ST-elevation are lacking; finally, which criteria among the multiple proposed, better define pathological Q-waves or success of revascularisation deserve further investigations. METHODS The Minimizing Adverse hemorrhagic events via TRansradial access site and systemic Implementation of AngioX (MATRIX) trial was designed to test the impact of bleeding avoidance strategies on ischemic and bleeding outcomes across the whole spectrum of patients with ACS receiving invasive management. The ECG-MATRIX is a pre-specified sub-study of the MATRIX programme which aims at analyzing the clinical value of ECG metrics in 4516 ACS patients (with and without ST-segment elevation in 2212 and 2304 cases, respectively) with matched pre and post-treatment ECGs. CONCLUSIONS This study represents a unique opportunity to further investigate the role of ECGs in the diagnosis and risk stratification of ACS patients with or without ST-segment deviation, as well as to assess whether the radial approach and bivalirudin may affect post-treatment ECG metrics and patterns in a large contemporary ACS population.
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