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Ishtiaq I, Zeb A, Badshah H, Alattar A, Alshaman R, Koh PO, Rehman NU, Shah FA, Althobaiti YS. Enhanced cardioprotective activity of ferulic acid-loaded solid lipid nanoparticle in an animal model of myocardial injury. Toxicol Appl Pharmacol 2023; 476:116657. [PMID: 37597755 DOI: 10.1016/j.taap.2023.116657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 08/13/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023]
Abstract
Myocardial infarction results in an increased inflammatory and oxidative stress response in the heart, and reducing inflammation and oxidative stress after MI may offer protective effects to the heart. In the present study, we examined the cardioprotective effects of ferulic acid (FA) and ferulic acid nanostructured solid lipid nanoparticles (FA-SLNs) in an isoproterenol (ISO) induced MI model. Male Sprague Dawley rats were divided into five experimental groups to compare the effects of FA and FA-SLNs. The findings revealed that ISO led to extensive cardiomyopathy, characterized by increased infarction area, edema formation, pressure load, and energy deprivation. Additionally, ISO increased the levels of inflammatory markers (COX-2, NLRP3, and NF-кB) and apoptotic mediators such as p-JNK. However, treatment with FA and FA-SLNs mitigated the severity of the ISO-induced response, and elevated the levels of antioxidant enzymes while downregulating inflammatory pathways, along with upregulation of the mitochondrial bioenergetic factor PPAR-γ. Furthermore, virtual docking analysis of FA with various protein targets supported the in vivo results, confirming drug-protein interactions. Overall, the results demonstrated that FA-SLNs offer a promising strategy for protecting the heart from further injury following MI. This is attributed to the improved drug delivery and therapeutic outcomes compared to FA alone.
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Affiliation(s)
- Isra Ishtiaq
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
| | - Ahmad Zeb
- Department of Pharmacy, Quaid-I-Azam University Islamabad, Pakistan
| | - Haroon Badshah
- Department of Pharmacy, Abdul Wali Khan University Mardan KP, Pakistan
| | - Abdullah Alattar
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Tabuk, Saudi Arabia
| | - Reem Alshaman
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Tabuk, Saudi Arabia
| | - Phil Ok Koh
- Department of Anatomy, College of Veterinary Medicine, Research Institute of Life Science, Gyeongsang National University, 501 Jinjudaero, Jinju 52828, South Korea
| | - Najeeb Ur Rehman
- Department of Pharmacology and Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Fawad Ali Shah
- Department of Pharmacology and Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia.
| | - Yusuf S Althobaiti
- Department of Pharmacology and Toxicology, College of Pharmacy, Addiction and Neuroscience Taif University, Taif 21944, Saudi Arabia.
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Tang S, Sha D, He Z, Chen X, Ma Y, Liu C, Yuan Y. Environmentally Adaptable Organo-Ionic Gel-Based Electrodes for Real-Time On-Skin Electrocardiography Monitoring. Adv Healthc Mater 2023; 12:e2300475. [PMID: 36892140 DOI: 10.1002/adhm.202300475] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Indexed: 03/10/2023]
Abstract
On-skin personal electrocardiography (ECG) devices, which can monitor real-time cardiac autonomic changes, have been widely applied to predict cardiac diseases and save lives. However, current interface electrodes fail to be unconditionally and universally applicable, often losing their efficiency and functionality under harsh atmospheric conditions (e.g., underwater, abnormal temperature, and humidity). Herein, an environmentally adaptable organo-ionic gel-based electrode (OIGE) is developed with a facile one-pot synthesis of highly conductive choline-based ionic liquid ([DMAEA-Q] [TFSI], I.L.) and monomers (2,2,2-trifluoroethyl acrylate (TFEA) and N-hydroxyethyl acrylamide (HEAA). In virtue of inherent conductivity, self-responsive hydrophobic barriers, dual-solvent effect, and multiple interfacial interactions, this OIGE features distinct sweat and water-resistance, anti-freezing and anti-dehydration properties with strong adhesiveness and electrical stability under all kinds of circumstances. In contrast to the dysfunction of commercial gel electrodes (CGEs), this OIGE with stronger adhesion as well as skin tolerability can realize a real-time and accurate collection of ECG signals under multiple extreme conditions, including aquatic environments (sweat and underwater), cryogenic (<-20°C) and arid (dehydration) environments. Therefore, the OIGE shows great prospects in diagnosing cardiovascular diseases and paves new horizons for multi-harsh environmental personalized healthcare.
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Affiliation(s)
- Shuaimin Tang
- Basic Science Center Project of National Natural Science Foundation of China, Key Laboratory for Ultrafine Materials of Ministry of Education, and School of Materials Science and Engineering, East China University of Science and Technology, Shanghai, 200237, P. R. China
- Frontiers Science Center for Materiobiology and Dynamic Chemistry, Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, 200237, Shanghai, P. R. China
| | - Dongyong Sha
- Basic Science Center Project of National Natural Science Foundation of China, Key Laboratory for Ultrafine Materials of Ministry of Education, and School of Materials Science and Engineering, East China University of Science and Technology, Shanghai, 200237, P. R. China
- Frontiers Science Center for Materiobiology and Dynamic Chemistry, Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, 200237, Shanghai, P. R. China
| | - Zirui He
- Basic Science Center Project of National Natural Science Foundation of China, Key Laboratory for Ultrafine Materials of Ministry of Education, and School of Materials Science and Engineering, East China University of Science and Technology, Shanghai, 200237, P. R. China
- Frontiers Science Center for Materiobiology and Dynamic Chemistry, Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, 200237, Shanghai, P. R. China
| | - Xi Chen
- Basic Science Center Project of National Natural Science Foundation of China, Key Laboratory for Ultrafine Materials of Ministry of Education, and School of Materials Science and Engineering, East China University of Science and Technology, Shanghai, 200237, P. R. China
- Frontiers Science Center for Materiobiology and Dynamic Chemistry, Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, 200237, Shanghai, P. R. China
- Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, Shanghai, 200237, P. R. China
| | - Yifan Ma
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, 43210, USA
| | - Changsheng Liu
- Basic Science Center Project of National Natural Science Foundation of China, Key Laboratory for Ultrafine Materials of Ministry of Education, and School of Materials Science and Engineering, East China University of Science and Technology, Shanghai, 200237, P. R. China
- Frontiers Science Center for Materiobiology and Dynamic Chemistry, Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, 200237, Shanghai, P. R. China
- Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, Shanghai, 200237, P. R. China
| | - Yuan Yuan
- Basic Science Center Project of National Natural Science Foundation of China, Key Laboratory for Ultrafine Materials of Ministry of Education, and School of Materials Science and Engineering, East China University of Science and Technology, Shanghai, 200237, P. R. China
- Frontiers Science Center for Materiobiology and Dynamic Chemistry, Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, 200237, Shanghai, P. R. China
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Kim SY, Lee JP, Shin WR, Oh IH, Ahn JY, Kim YH. Cardiac biomarkers and detection methods for myocardial infarction. Mol Cell Toxicol 2022; 18:443-455. [PMID: 36105117 PMCID: PMC9463516 DOI: 10.1007/s13273-022-00287-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2022] [Indexed: 12/14/2022]
Abstract
Background A significant heart attack known as a myocardial infarction (MI) occurs when the blood supply to the heart is suddenly interrupted, harming the heart muscles due to a lack of oxygen. The incidence of myocardial infarction is increasing worldwide. A relationship between COVID-19 and myocardial infarction due to the recent COVID-19 pandemic has also been revealed. Objective We propose a biomarker and a method that can be used for the diagnosis of myocardial infarction, and an aptamer-based approach. Results For the diagnosis of myocardial infarction, an algorithm-based diagnosis method was developed using electrocardiogram data. A diagnosis method through biomarker detection was then developed. Conclusion Myocardial infarction is a disease that is difficult to diagnose based on the aspect of a single factor. For this reason, it is necessary to use a combination of various methods to diagnose myocardial infarction quickly and accurately. In addition, new materials such as aptamers must be grafted and integrated into new ways. Purpose of Review The incidence of myocardial infarction is increasing worldwide, and some studies are being conducted on the association between COVID-19 and myocardial infarction. The key to properly treating myocardial infarction is early detection, thus we aim to do this by offering both tools and techniques as well as the most recent diagnostic techniques. Recent Findings Myocardial infarction is diagnosed using an electrocardiogram and echocardiogram, which utilize cardiac signals. It is required to identify biomarkers of myocardial infarction and use biomarker-based ELISA, SPR, gold nanoparticle, and aptamer technologies in order to correctly diagnose myocardial infarction.
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Affiliation(s)
- Sang Young Kim
- Department of Food Science and Biotechnology, Shin Ansan University, 135 Sinansandaehak-Ro, Danwon-Gu, Ansan, 15435 Republic of Korea
| | - Jin-Pyo Lee
- School of Biological Sciences, Chungbuk National University, 1 Chungdae-Ro, Seowon-Gu, Cheongju 28644 South Korea
| | - Woo-Ri Shin
- School of Biological Sciences, Chungbuk National University, 1 Chungdae-Ro, Seowon-Gu, Cheongju 28644 South Korea
| | - In-Hwan Oh
- School of Biological Sciences, Chungbuk National University, 1 Chungdae-Ro, Seowon-Gu, Cheongju 28644 South Korea
| | - Ji-Young Ahn
- School of Biological Sciences, Chungbuk National University, 1 Chungdae-Ro, Seowon-Gu, Cheongju 28644 South Korea
| | - Yang-Hoon Kim
- School of Biological Sciences, Chungbuk National University, 1 Chungdae-Ro, Seowon-Gu, Cheongju 28644 South Korea
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Kazama I, Kuwana R, Muto M, Nagano A, Fujimura R, Asada A, Tamada T, Shimoyama M. Subepicardial burn injuries in bullfrog heart induce electrocardiogram changes mimicking inferior wall myocardial infarction. J Vet Med Sci 2022; 84:1205-1210. [PMID: 35811132 PMCID: PMC9523291 DOI: 10.1292/jvms.22-0243] [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] [Indexed: 11/28/2022] Open
Abstract
Using bullfrog hearts, we previously reproduced a ST segment elevation in electrocardiogram (ECG), mimicking human ischemic heart disease. In the present study, by inducing subepicardial
burn injuries on the inferior part of the frog heart ventricle, we could reproduce typical ECG changes observed in human inferior wall myocardial infarction, such as the marked elevation of
the ST segments in inferior limb leads (II, III, aVF) and their reciprocal depression in the opposite limb leads (I, aVL). Due to the decrease in Na+/K+-ATPase protein
expression, the resting membrane potential of injured cardiomyocytes shifted toward depolarization. Such induced electrical difference between the injured and intact cardiomyocytes was
thought to be responsible for the creation of “currents of injury” and the subsequent ST segment changes.
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Affiliation(s)
| | | | | | | | | | | | - Tsutomu Tamada
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine
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Pessah MA, Huhtala H, Kosonen P, Eskola M, Pérez-Riera AR, Nikus K, Rankinen J. Early ischemic ST-segment and T-wave changes during balloon angioplasty. J Electrocardiol 2022; 73:87-95. [PMID: 35738147 DOI: 10.1016/j.jelectrocard.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Acute coronary occlusion results in increased T-wave amplitude and ST-segment elevation in the ECG leads facing the ischemic region. MATERIAL AND METHODS We performed continuous ECG recording in 34 patients during balloon occlusion of the left anterior descending (LAD), left circumflex (LCx) and right coronary artery (RCA). Delta (Δ) ST and ΔT amplitudes were calculated by subtracting the preinflation values from the values measured during balloon inflation. RESULTS Occlusion of the LAD resulted in greater increase in the amplitude of the T wave than of the ST segment in lead V2 (ΔT +3.4 mm, inter-quartile range [IQR] 1-6 mm; ΔST +1.4 mm, 0.5-3 mm). During RCA occlusion, ΔST and ΔT didn't differ significantly. LCx occlusion resulted in significant differences between ΔST and ΔT in all leads, except aVF and V3-V4. In two patients (LCx), we observed a biphasic ST-T response: an initial negative change of the T-wave amplitude was followed by a positive change in leads V1-V2. In leads II, III, aVF and V4-V6, there was an initial positive change, followed by a final negative change towards the end of the occlusion. CONCLUSION Continuous 12‑lead ECG recording during balloon occlusion of the LCx resulted in significant differences between the ΔST and ΔT values in all leads except aVF and V3-V4. LAD and RCA occlusion resulted in less evident differences between the ST-segment and T-wave changes. A change in polarity of T-wave changes during balloon occlusion (initial negative and final positive change, or vice versa) proved to be a rare finding.
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Affiliation(s)
- Mazal-Anna Pessah
- Tampere University, Faculty of Medicine and Health Technology, Finnish Cardiovascular Research Center, Tampere, Finland
| | - Heini Huhtala
- Tampere University, Faculty of Social Sciences, Tampere, Finland
| | | | | | - Andrés Ricardo Pérez-Riera
- Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário Saúde ABC, Santo André, São Paulo, Brazil
| | - Kjell Nikus
- Tampere University, Faculty of Medicine and Health Technology, Finnish Cardiovascular Research Center, Tampere, Finland; Heart Center, Tampere University Hospital, Finland.
| | - Jani Rankinen
- Tampere University, Faculty of Medicine and Health Technology, Finnish Cardiovascular Research Center, Tampere, Finland
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Rostamzadeh F, Najafipour H, Jafarinejad-Farsangi S, Ansari-Asl Z. Beneficial effects of PEGylated graphene quantum dot on arrhythmias induced by myocardial infarction. Biotechnol Appl Biochem 2021; 69:2222-2228. [PMID: 34766653 DOI: 10.1002/bab.2280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/06/2021] [Indexed: 11/10/2022]
Abstract
Arrhythmias are one of the leading causes of early death following myocardial infarction (MI) and heart failure. Graphene derivatives have emerged as an therapeutic target that have electrical conductivity. The study aimed to evaluate the impacts of polyethylene glycol-graphene quantum dots (GQDs-PEG) on arrhythmias created by MI in the rat. Animals were randomly assigned to five groups of sham, MI, and MI + GQDs-PEG at doses of 5, 10, and 20 mg/kg. MI was induced by the closure of the left anterior descending artery. The day after MI, animals were administered vehicle (phosphate buffered saline) or GQDs-PEG at different doses every other day for 2 weeks. On day 15, electrocardiogram (ECG), mean arterial pressure (MAP), and heart contractility indices were recorded by the PowerLab data acquisition system. GQDs-PEG 20 mg/kg increased contractility and improved the reduction of MAP in the MI group. The prolonged QT and QTc intervals, inverted T wave, and deviated ST segment were modified by GQDs-PEG 10 and 20 mg/kg in rats with MI. The amplitude of the Q wave was also decreased in a dose-dependent manner in the GQDs-PEG-treated rats. The results demonstrated that 2 weeks of treatment with GQDs-PEG normalized ECG abnormalities and improved left ventricular dysfunction in rats with MI.
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Affiliation(s)
- Farzaneh Rostamzadeh
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Najafipour
- Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Saeideh Jafarinejad-Farsangi
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Zeinab Ansari-Asl
- Department of Chemistry, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran
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Kasprzak M, Fabiszak T, Koziński M, Kubica J. Diagnostic Performance of Selected Baseline Electrocardiographic Parameters for Prediction of Left Ventricular Remodeling in Patients with ST-Segment Elevation Myocardial Infarction. J Clin Med 2021; 10:jcm10112405. [PMID: 34072364 PMCID: PMC8198269 DOI: 10.3390/jcm10112405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To evaluate the diagnostic performance of selected baseline electrocardiographic (ECG) parameters as predictors of left ventricular remodeling (LVR) in patients with a first ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Methods: The study was performed as a single-center cohort study, with 249 patients (74.7% males) included in the final analysis. Nine baseline ECG parameters were evaluated, with respect to occurrence of LVR 6 months after STEMI (defined as an echocardiography-assessed relative >20% increase in end-diastolic left ventricular volume compared with the value at discharge from hospital). Results: The baseline ECG predictors of LVR, identified in univariate analysis, included the number of leads with ST-segment elevation (odds ratio (OR) 1.19, 95% confidence interval (CI) 1.03–1.38, p = 0.0212), number of leads with Q-waves (OR 1.21, 95% CI 1.07–1.37, p = 0.0033), sum of ST-segment elevation (OR 1.04, 95% CI 1.00–1.08; p = 0.0253) and maximal ST-segment elevation (OR 1.14; 95% CI 1.00–1.29; p = 0.0446). When added to demographic, clinical and angiographic data, the number of leads with ST-segment elevation (OR 1.17, 95% CI 1.01–1.36; p = 0.0413), number of leads with Q-waves (OR 1.15, 95% CI 1.01–1.32; p = 0.0354) and the sum of ST-segment elevation (OR 1.04, 95% CI 1.00–1.08; p = 0.0331) successfully predicted development of LVR in multivariate logistic regression models. However, after inclusion of biochemical data in multivariate models, none of the electrocardiographic parameters, but increasing body weight, TIMI flow after PCI < 3 and higher maximal values of myocardial necrosis biomarker, was independently associated with the occurrence of LVR 6 months after STEMI. Conclusions: Our study demonstrates modest utility of pre-reperfusion ECG for the prediction of LVR occurrence after six months of STEMI.
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Affiliation(s)
- Michał Kasprzak
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. M. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (T.F.); (J.K.)
- Correspondence: ; Tel.: +48-52-585-4023; Fax: +48-52-585-4024
| | - Tomasz Fabiszak
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. M. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (T.F.); (J.K.)
| | - Marek Koziński
- Department of Cardiology and Internal Medicine, Medical University of Gdansk, ul. Powstania Styczniowego 9B, 81-519 Gdynia, Poland;
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. M. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (T.F.); (J.K.)
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Beck S, Martínez Pereyra V, Seitz A, Bekeredjian R, Sechtem U, Ong P. [Detection of ECG alterations typical for myocardial ischemia : New methods 2021]. Internist (Berl) 2021; 62:665-671. [PMID: 34041581 DOI: 10.1007/s00108-021-01037-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The electrocardiogram (ECG) represents an essential diagnostic tool in cardiology and beyond. Classical ECG devices enable the registration of up to 12 leads, whereas modern ECG systems enable additional leads even with a reduced number of electrodes. Additionally, "smart" devices even enable patients to record an ECG at home. OBJECTIVE Evaluation of a potential additional benefit of using various modern ECG systems for the detection of ECG alterations typical for myocardial ischemia. MATERIAL AND METHODS Presentation of various signs of ischemia in the ECG according to the latest guidelines. Demonstration of modern ECG systems and their potential advantage in the detection of signs of ischemia in the ECG based on current study results. RESULTS Modern ECG systems with vector-based electrocardiography can facilitate and optimize the detection of ischemic ECG alterations. Smart nonvector-based devices for patients are primarily useful for detection of arrhythmias and do not replace the 12-lead ECG for detection of ischemia, even though they can be useful for documentation of temporary ECG alterations also within the ST-segment. CONCLUSION The ECG systems based on vector electrocardiography can improve the detection of ECG alterations typical for ischemia compared to the conventional 12-lead ECG.
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Affiliation(s)
- Sascha Beck
- Abteilung für Kardiologie und Angiologie, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland
| | - Valeria Martínez Pereyra
- Abteilung für Kardiologie und Angiologie, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland
| | - Andreas Seitz
- Abteilung für Kardiologie und Angiologie, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland
| | - Raffi Bekeredjian
- Abteilung für Kardiologie und Angiologie, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland
| | - Udo Sechtem
- Abteilung für Kardiologie und Angiologie, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland
| | - Peter Ong
- Abteilung für Kardiologie und Angiologie, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland.
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Lo LW, Zhao J, Wan H, Wang Y, Chakrabartty S, Wang C. An Inkjet-Printed PEDOT:PSS-Based Stretchable Conductor for Wearable Health Monitoring Device Applications. ACS APPLIED MATERIALS & INTERFACES 2021; 13:21693-21702. [PMID: 33926183 DOI: 10.1021/acsami.1c00537] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A stretchable conductor is one of the key components in soft electronics that allows the seamless integration of electronic devices and sensors on elastic substrates. Its unique advantages of mechanical flexibility and stretchability have enabled a variety of wearable bioelectronic devices that can conformably adapt to curved skin surfaces for long-term health monitoring applications. Here, we report a poly(3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS)-based stretchable polymer blend that can be patterned using an inkjet printing process while exhibiting low sheet resistance and accommodating large mechanical deformations. We have systematically studied the effect of various types of polar solvent additives that can help induce phase separation of PEDOT and PSS grains and change the conformation of a PEDOT chain, thereby improving the electrical property of the film by facilitating charge hopping along the percolating PEDOT network. The optimal ink formulation is achieved by adding 5 wt % ethylene glycol into a pristine PEDOT:PSS aqueous solution, which results in a sheet resistance of as low as 58 Ω/□. Elasticity can also be achieved by blending the above solution with the soft polymer poly(ethylene oxide) (PEO). Thin films of PEDOT:PSS/PEO polymer blends patterned by inkjet printing exhibits a low sheet resistance of 84 Ω/□ and can resist up to 50% tensile strain with minimal changes in electrical performance. With its good conductivity and elasticity, we have further demonstrated the use of the polymer blend as stretchable interconnects and stretchable dry electrodes on a thin polydimethylsiloxane (PDMS) substrate for photoplethysmography (PPG) and electrocardiography (ECG) recording applications. This work shows the potential of using a printed stretchable conducting polymer in low-cost wearable sensor patches for smart health applications.
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Affiliation(s)
- Li-Wei Lo
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
- Institute of Materials Science and Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
| | - Junyi Zhao
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
| | - Haochuan Wan
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
| | - Yong Wang
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
- Department of Obstetrics & Gynecology, Washington University in St. Louis, St. Louis, Missouri 63130, United States
| | - Shantanu Chakrabartty
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
| | - Chuan Wang
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
- Institute of Materials Science and Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
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Shemirani H, Mir-Amirkhani F, Mansouri MH, Zavar R, Mansouri P. The relationship of the changes in lateral leads I and aVL in electrocardiogram with echocardiography and coronary angiography findings in patients with acute coronary syndrome. ARYA ATHEROSCLEROSIS 2021; 17:1-6. [PMID: 35685823 PMCID: PMC9133705 DOI: 10.22122/arya.v17i0.2105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/14/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Electrocardiographic (ECG) study is a principle for the symptoms contributed to the acute myocardial infarction (AMI)/acute coronary syndrome (ACS). The diagnosis of involved coronary artery based on ECG changes is still a challenge. This study is aimed to evaluate the association of mere changes in I and aVL leads with the involved region found through echocardiography and involved coronary artery through angiography. METHODS This cross-sectional study was conducted on 100 patients referred with AMI/ACS symptoms that had mere ECG changes in I and aVL leads (ST elevation + Q wave/ST depression + inverted-T). Transthoracic echocardiography (TTE) and coronary angiography (CAG) were performed for the patients. The correlation of ECG with echocardiography and angiography was assessed. RESULTS Among the studied population, 39 patients (39%) were women with the mean ± standard deviation (SD) of age of 64.60 ± 9.39 years. There was no significant association between ECG changes in leads I and aVL with neither the stenosis of first diagonal (D1) coronary artery found through angiography (P = 0.580) nor the mid-anterior wall dyskinesia found through echocardiography (P = 0.380). A remarkable association between the echocardiographic findings representing mid-anterior wall ischemic dyskinesia with the stenosis of D1 coronary artery was detected (P < 0.001). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100%, 54.54%, 94.68%, and 100% were respectively found as the diagnostic values of mentioned factors. CONCLUSION Our findings showed significant association between D1 involvement and mid-anterior dyskinesia in echocardiography, while the changes in ECG were associated neither with echocardiographic nor angiographic outcomes.
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Affiliation(s)
- Hasan Shemirani
- Professor, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzad Mir-Amirkhani
- Cardiologist, Chamran Cardiovascular Medical and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hadi Mansouri
- Assistant Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Mohammad Hadi Mansouri; Assistant Professor, Isfahan Cardiovascular Research Center, Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran;
| | - Reihaneh Zavar
- Assistant Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pejman Mansouri
- Resident, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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11
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Balbi MM, Scarparo P, Tovar MN, Masdjedi K, Daemen J, Den Dekker W, Ligthart J, Witberg K, Cummins P, Wilschut J, Zijlstra F, Van Mieghem NM, Diletti R. Culprit lesion detection in patients presenting with non-ST elevation acute coronary syndrome and multivessel disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:110-118. [PMID: 33839051 DOI: 10.1016/j.carrev.2021.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/05/2021] [Accepted: 03/17/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND/PURPOSE Identification of the culprit lesion in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) allows appropriate coronary revascularization but may be unclear in patients with multivessel coronary disease (MVD). Therefore, we investigated the rate of culprit lesion identification during coronary angiography in NSTE-ACS and multivessel disease. METHODS/MATERIALS Consecutive patients presenting with NSTE-ACS and MVD, between January 2012 and December 2016 were evaluated. Coronary angiograms, intravascular imaging, and ECGs were analyzed for culprit lesion identification. Long-term clinical outcomes in terms of major adverse cardiac events (MACE) and mortality were reported in patients with or without culprit identification. RESULTS A total of 1107 patients with NSTE-ACS and MVD were included in the analysis, 310 (28.0%) with unstable angina and 797 (72.0%) with non-ST elevation myocardial infarction. The culprit lesion was angiographically identified in 952 (86.0%) patients, while no clear culprit lesion was found in 155 (14.0%) patients. ECG analysis allowed to predict the location of the culprit vessel with low sensitivity (range 28.4%-36.7%) and high specificity (range 90.6%-96.5%). Higher lesion complexity was associated with inability to identify the culprit. Intravascular imaging was applied in 55 patients and helped to identify the culprit lesion in 53 patients (96.4%). There was no difference in all-cause mortality (21.4% vs. 25.8%, p = 0.24) and MACE (39.2% vs. 47.6%, p = 0.07) between the cohorts with or without culprit lesion identification by angiography. CONCLUSIONS The culprit lesion appeared unclear by coronary angiography in >10% of patients with NSTE-ACS and MVD. Complementary invasive imaging substantially enhanced the diagnostic accuracy of culprit lesion detection.
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Affiliation(s)
- Matthew Mercieca Balbi
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Paola Scarparo
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Maria Natalia Tovar
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Kaneshka Masdjedi
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Wijnand Den Dekker
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Jurgen Ligthart
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Karen Witberg
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Paul Cummins
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Jeroen Wilschut
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Felix Zijlstra
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands.
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12
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Ghani AR, Mughal MS, Kumar S, Muskula P, Abo-Salem E. Wrapped Left Anterior Descending Artery Presenting As Inferior Myocardial Infarction: Case Report and Review of the Literature. Cureus 2021; 13:e13358. [PMID: 33754091 PMCID: PMC7971711 DOI: 10.7759/cureus.13358] [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] [Indexed: 11/15/2022] Open
Abstract
Acute occlusion of the left anterior descending (LAD) coronary artery generally results in ST-segment elevation in the anterior leads of the electrocardiogram and reciprocal ST-segment depression in the inferior leads. We present a case of LAD occlusion presenting as inferior wall ST-segment elevation myocardial infarction.
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Affiliation(s)
- Ali R Ghani
- Department of Cardiology, Saint Louis University Hospital, St. Louis, USA
| | - Mohsin S Mughal
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | - Sundeep Kumar
- Department of Cardiology, Saint Louis University Hospital, St. Louis, USA
| | - Preetham Muskula
- Department of Cardiology, Saint Louis University Hospital, St. Louis, USA
| | - Elsayed Abo-Salem
- Department of Cardiology, Saint Louis University Hospital, St. Louis, USA
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13
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Solsi A, Gandhi DD. An Unusual Case of ST Elevation Myocardial Infarction in Angiographically Non-Obstructed Coronary Arteries. Cureus 2021; 13:e12657. [PMID: 33585142 PMCID: PMC7872888 DOI: 10.7759/cureus.12657] [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] [Accepted: 01/11/2021] [Indexed: 11/24/2022] Open
Abstract
It is routinely believed that patients with electrocardiographic findings of ST elevation myocardial infarction (STEMI) will have evidence of obstructive coronary artery disease on coronary angiography. Although this is the situation in the majority of STEMI instances, in a small percentage of cases, patients presenting with STEMI are found to have minimal to no coronary artery blockage on subsequent angiography, termed MI with non-obstructive coronary arteries (MINOCA). MINOCA is a heterogenous entity with multiple causes, making a focused diagnostic workup important to select an appropriate treatment, with the goal to prevent a mortality similar to obstructive coronary disease. In this case, we describe a unique presentation of MINOCA, after a patient was diagnosed with STEMI.
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Affiliation(s)
- Anup Solsi
- Internal Medicine, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Daisy D Gandhi
- Internal Medicine, International American University College of Medicine, Phoenix, USA
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14
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Electrocardiographic identification of the culprit coronary artery in acute non-ST-elevation myocardial infarction: predictive value of N-wave and T-wave precordial instability. Coron Artery Dis 2020; 31:590-596. [PMID: 32568742 DOI: 10.1097/mca.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recently, novel ischemic electrocardiographic changes have been described, which may be clinically significant in the identification of the culprit coronary vessel in patients with non-ST-elevation myocardial infarction (NSTEMI). We sought to determine the predictive value of N-wave, T-wave precordial instability, de-Winter ST/T-wave complex, and inferolateral myocardial infarction in the identification of the culprit artery in patients with NSTEMI referred for early invasive (<24 h) treatment. METHODS A total of 148 patients with NSTEMI, aged 40-91 years, were enrolled from a cohort of 510 consecutive NSTEMI subjects, hospitalized in our center in 2015-2017. RESULTS Of the evaluated ischemic ECG changes, the most common finding in patients with culprit left circumflex (LCx)/obtuse marginal artery or right coronary artery was T-wave precordial instability (28.3 and 13.5%, respectively), whereas in individuals with culprit left anterior descending/diagonal artery, T-wave precordial instability and N-wave in leads II, III or aVF occurred equally often (16.0%). A significant relationship was found between the occurrence of N-wave in inferolateral leads and culprit LCx/obtuse marginal. In multivariable analysis, N-wave in lead aVL [odds ratio (OR) 2.10; 95% confidence interval (CI), 1.15-3.81], and T-wave precordial instability (OR 1.56; 95% CI, 1.02-2.41) were independent predictors of culprit LCx/obtuse marginal. The accuracy of N-wave in lead aVL in predicting the culprit LCx/obtuse marginal was 73.9% and was higher than the accuracy of T-wave precordial instability, which was 69.1%. CONCLUSIONS In patients with NSTEMI referred for early invasive treatment, the presence of N-wave or T-wave precordial instability may be of greater clinical importance in the prediction of culprit LCx/obtuse marginal than classic ischemic changes.
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15
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Shigotarova EA, Galimskaja VA, Golubeva AV, Oleynikov VE. [The myocardial infarction size measuring using modern methods]. TERAPEVT ARKH 2020; 92:105-110. [PMID: 32598707 DOI: 10.26442/00403660.2020.04.000571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 11/22/2022]
Abstract
An accurate quantitative assessment of myocardium necrosis area and the viable zone (stunned and hibernating) in patients with myocardial infarction is crucial for the preoperative patient selection and predicting the cardiac surgery effectiveness. Currently, researchers and clinicians are most interested in the problem of determining the viable myocardium zone. However, only the necrosis zone area directly correlates with the patients prognosis and determines the heart pathological remodeling processes. In the distant period, the data obtained can be used to predict the post-infarction period course or for analysis the relationship of the necrosis zone with arrhythmogenesis, and a number of other indicators. Thus, the necrosis zone and the viable myocardium zone are two parameters that need to be monitored in dynamics in all patients after myocardial infarction. The most accurate and reproducible method for determining the necrosis area is contrast magnetic resonance imaging of the heart, however, this technique is still inaccessible in most hospitals. In this regard, it remains relevant to estimate the necrotic myocardium area by ubiquitous non-invasive methods such as electrocardiography and echocardiography.
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16
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Du YT, Pasupathy S, Air T, Neil C, Beltrame JF. Validation of contemporary electrocardiographic indices of area at risk and infarct size in acute ST elevation myocardial infarction (STEMI). Int J Cardiol 2020; 303:1-7. [PMID: 31759688 DOI: 10.1016/j.ijcard.2019.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/16/2019] [Accepted: 10/24/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Electrocardiographic (ECG) methods to assess area at risk (AAR) and infarct size (IS) in patients with ST-elevation myocardial infarction (STEMI) have been previously established but not validated against contemporary benchmark Cardiac Magnetic Resonance (CMR) measures. We compared ECG-determined and CMR-determined measures for (a) AAR, (b) IS, and (c) myocardial salvage. METHODS Sixty patients with ECG evidence of STEMI and CMR imaging performed within 13 days were included. The ECG-determined (a) AAR scores (Aldrich and Wilkins), (b) IS (Selvester score), and (c) myocardial salvage (i.e. [AAR-IS] / AAR × 100%), were compared with CMR-determined measures. RESULTS Compared with CMR-determined AAR, both the Wilkins & Aldrich scores underestimated AAR, although the Wilkins (r = 0.72, p < 0.001) showed a better correlation than the Aldrich (r = 0.54, p < 0.001). Bland-Altman analysis revealed a bias of 2.6% (95% limits of agreement: 18.5%, -13.3%) for the Wilkins and 5.9% (95% limits of agreement: 25.6%, -13.8%) for the Aldrich. Estimation of IS was similar between the Selvester score and CMR, with good correlation (r = 0.77, p < 0.001) and agreement (fixed bias 0.4%, 95% limits of agreement 20.8%, -15.5%). However, ECG-determined myocardial salvage significantly underestimated CMR-determined myocardial salvage, with an inverse correlation (r = -0.33, p = 0.01). CONCLUSIONS The Wilkins score is superior to Aldrich score as an ECG-AAR index, Selvester score is a reasonable ECG estimate of infarct size, though ECG derived myocardial salvage does not have enough accuracy to be used in the clinical setting; it may be an inexpensive surrogate for myocardial salvage in large research studies. Further validation and prognostic studies are required.
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Affiliation(s)
- Yang Timothy Du
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia; Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Sivabaskari Pasupathy
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia; Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Tracy Air
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Christopher Neil
- Department of Medicine, Western Health, University of Melbourne, Melbourne, Australia; Department of Cardiology, Western Health, Melbourne, Australia
| | - John F Beltrame
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia; Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
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17
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Huang SC, Chen LH, Wu LW. Acute myocardial infarction presented with isolated precordial lead elevation in V2. JOURNAL OF MEDICAL SCIENCES 2020. [DOI: 10.4103/jmedsci.jmedsci_1_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Coronary Artery Disease: From Mechanism to Clinical Practice. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1177:1-36. [PMID: 32246442 DOI: 10.1007/978-981-15-2517-9_1] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In most developed countries, coronary artery disease (CAD), mostly caused by atherosclerosis of coronary arteries, is one of the primary causes of death. From 1990s to 2000s, mortality caused by acute MI declined up to 50%. The incidence of CAD is related with age, gender, economic, etc. Atherosclerosis contains some highly correlative processes such as lipid disturbances, thrombosis, inflammation, vascular smooth cell activation, remodeling, platelet activation, endothelial dysfunction, oxidative stress, altered matrix metabolism, and genetic factors. Risk factors of CAD exist among many individuals of the general population, which includes hypertension, lipids and lipoproteins metabolism disturbances, diabetes mellitus, chronic kidney disease, age, genders, lifestyle, cigarette smoking, diet, obesity, and family history. Angina pectoris is caused by myocardial ischemia in the main expression of pain in the chest or adjoining area, which is usually a result of exertion and related to myocardial function disorder. Typical angina pectoris would last for minutes with gradual exacerbation. Rest, sit, or stop walking are the usual preference for patients with angina, and reaching the maximum intensity in seconds is uncommon. Rest or nitroglycerin usage can relieve typical angina pectoris within minutes. So far, a widely accepted angina pectoris severity grading system included CCS (Canadian Cardiovascular Society) classification, Califf score, and Goldman scale. Patients with ST-segment elevated myocardial infarction (STEMI) may have different symptoms and signs of both severe angina pectoris and various complications. The combination of rising usage of sensitive MI biomarkers and precise imaging techniques, including electrocardiograph (ECG), computed tomography, and cardiac magnetic resonance imaging, made the new MI criteria necessary. Complications of acute myocardial infarction include left ventricular dysfunction, cardiogenic shock, structural complications, arrhythmia, recurrent chest discomfort, recurrent ischemia and infarction, pericardial effusion, pericarditis, post-myocardial infarction syndrome, venous thrombosis pulmonary embolism, left ventricular aneurysm, left ventricular thrombus, and arterial embolism.
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19
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Shenouda RB, Bytyçi I, Sobhy M, Henein MY. Reduced regional strain rate is the most accurate dysfunction in predicting culprit lesions in patients with acute coronary syndrome. Clin Physiol Funct Imaging 2019; 40:21-29. [PMID: 31549763 DOI: 10.1111/cpf.12597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/17/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM Predicting culprit lesions in acute coronary syndrome (ACS) could be a challenge. The aim of this study was to assess the accuracy of regional wall motion abnormalities (RWMA) using various echocardiographic techniques and ECG changes in predicting the culprit coronary lesion in a group of patients with ACS. METHODS In 80 consecutive patients with ACS (age 55·7 ± 9·4 years, 77% male, 15% with CCS Angina III), an echocardiographic examination of left ventricle (LV) RWMA, tissue Doppler imaging (TDI) and speckle tracking myocardial strain and strain rate (SR) were performed before intervention. RESULTS Of the 80 patients, one-vessel stenosis (>70%) was present in 53 (66%), two-vessel disease in 12 (15%) and multivessel disease in 15 patients (19%). About 51% of patients had hypertension, 40% diabetes and 23% dyslipidaemia. There was no relationship between individual segmental RWMA and SR. Mean regional SR, but not peak strain, correlated with culprit lesion branch: left anterior descending - LAD (r = 0·35, P = 0·005), circumflex LCx (r = 0·32, P = 0·03) and right coronary RCA (r = 0·37, P = 0·01). Only ECG changes in the LAD territory (r = 0·26, P = 0·04) correlated with the culprit lesion. SR of LAD territories ≤-0·74 was 71% sensitive and 70% specific (AUC = 0·70, CI = 0·67-0·93, P = 0·01), SR of LCx territories of ≤-0·67 was 75% sensitive and 63% specific (AUC = 0·72, CI = 0·58-0·87, P = 0·02) and SR of RCA territories ≤-0·83 was 73% sensitive and 71% specific (AUC = 0·80, CI = 0·66-0·93, P = 0·001) in predicting significant stenosis. SR was more accurate than all other techniques in predicting the culprit lesion. CONCLUSION In ACS, mean regional speckle tracking SR is more sensitive than peak strain, TDI, ECG changes and wall motion abnormalities in detecting significant coronary artery stenosis.
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Affiliation(s)
- Rafik B Shenouda
- International Cardiac Centre, Alexandria, Egypt.,Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ibadete Bytyçi
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Albania
| | - Mohammed Sobhy
- International Cardiac Centre, Alexandria, Egypt.,Cardiology Department, Alexandria University, Alexandria, Egypt
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Molecular and Clinic Research Institute, St George University, London, UK.,Brunel University, Uxbridge, UK
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20
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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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Toluey M, Ghaffari S, Tajlil A, Nasiri B, Rostami A. The impact of cigarette smoking on infarct location and in-hospital outcome following acute ST-elevation myocardial infarction. J Cardiovasc Thorac Res 2019; 11:209-215. [PMID: 31579461 PMCID: PMC6759623 DOI: 10.15171/jcvtr.2019.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 07/19/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction: Smoking, which is a major modifiable risk factor for coronary artery diseases, affects cardiovascular system with different mechanisms. We designed this study to investigate the association of smoking with location of ST-segment elevation myocardial infarction (STEMI), and short-term outcomes during hospitalization. Methods: In 1017 consecutive patients with anterior/inferior STEMI, comprehensive demographic, biochemical data, as well as clinical complications and mortality rate, were recorded. Patients were allocated into two groups based on smoking status and compared regarding the location of myocardial infarction, the emergence of clinical complications and in-hospital mortality in univariate and multivariate logistic regression analysis. Results: Among 1017 patients, 300 patients (29.5%) were smoker and 717 patients (70.5 %) were non-smoker. Smokers were significantly younger and had lower prevalence of diabetes, hyperlipidemia and hypertension. Inferior myocardial infarction was considerably more common in smokers than in non-smokers (45.7% vs. 36%, P = 0.001). Heart failure was developed more commonly in non-smokers (33.9% vs. 20%, P = 0.001). In-hospital mortality was significantly lower in smokers (6.7% vs. 17.3%, P = 0.001). After adjustment for confounding variables, smoking was independently associated with inferior myocardial infarction and lower heart failure [odds ratio: 1.44 (1.06-1.96), P = 0.01 and odds ratio: 0.61 (0.40-0.92), P = 0.02, respectively]. However, in-hospital mortality was not associated with smoking after adjustment for other factors [odds ratio: 0.69 (0.36-1.31), P = 0.2]. Conclusion: Smoking is independently associated with inferior myocardial infarction. Although smokers had lower incidence of heart failure, in-hospital mortality was not different after adjustment for other factors.
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Affiliation(s)
| | | | | | - Babak Nasiri
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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22
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Fallahi A, Khorram HG, Kokabi A. Electrocardiogram signal generation using electrical model of cardiac cell: application in cardiac ischemia. J Med Eng Technol 2019; 43:207-216. [PMID: 31353984 DOI: 10.1080/03091902.2019.1645221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
One of the most common causes of heart failure is ischaemia. In this disease, the heart muscles die due to the lack or insufficiency of the blood in the cardiac veins. As a result of such a phenomenon, the action potential in that part of the heart would fade. In this article, using the electric model of the cardiac cell and the mechanism of producing an ECG signal in the heart, the process of producing cardiac electrical potential has been modelled. In this regard, the basic constituent signals of the ECG are generated. Afterward, by accumulating these signals, the final ECG is reproduced. In addition, by variation of the presented model parameters, the cardiac ischaemic signal is simulated in a way that the influence of ventricle ischaemia on the ventricular tissues is considered. The results of such a simulation demonstrate a sufficient match between the model output and the reported changes of the cardiac arrhythmia including ischaemic failures. Here, we report the 91% match between the simulated signal and the considered clinical data.
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Affiliation(s)
- Alireza Fallahi
- Biomedical Engineering Department, Shahed University , Tehran , Iran.,Department of Biomedical Engineering, Hamedan University of Technology , Hamedan , Iran
| | | | - Alireza Kokabi
- Department of Electrical Engineering, Hamedan University of Technology , Hamedan , Iran
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23
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Gifft K, Dohrmann M, Eniezat M, Enezate T. Effect of infarct site on the clinical endpoints of thrombolytic-treated ST-elevation myocardial infarction. Am J Emerg Med 2019; 38:79-82. [PMID: 31005391 DOI: 10.1016/j.ajem.2019.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Some studies suggest better outcomes after the use of thrombolytics in inferior ST-elevation myocardial infarction (STEMI) compared to other locations. The goal of this study is to compare the clinical endpoints of thrombolytic-treated STEMI based on coronary artery distribution. METHODS The study population was extracted from the 2014 Nationwide Readmissions Data using the International Classification of Diseases, Ninth Revision, Clinical Modifications codes for STEMI, thrombolytic infusion, and complications of STEMI. Primary study endpoints included in-hospital all-cause mortality, length of hospital stay (LOS), cardiogenic shock, and mechanical complications of STEMI. RESULTS A principal diagnosis of thrombolytic-treated STEMI was identified for in 1231 patients (mean age 61.5 years; 26.5% female). Four hundred and thirty-one STEMIs occurred in the left anterior descending (LAD) artery distribution, 124 in the left circumflex (LCX) artery distribution, and 676 in the right coronary artery (RCA) distribution. In comparison to the LAD and LCX distributions, thrombolytic-treated STEMIs in the RCA distribution were associated with lower mortality (6.5% with LAD, 5.7% with LCX, and 3.6% with RCA; p = 0.02), fewer cardiogenic shock (12.3% with LAD, 12.1% with LCX, and 7.7% with RCA; p = 0.01), and shorter LOS (4.5 days with LAD, 3.9 with LCX, and 3.6 days with RCA; p < 0.01). Mechanical complications showed no significant difference based on coronary distribution (2.3% with LAD, 3.2% with LCX, and 1.2% with RCA; p = 0.17). CONCLUSIONS Thrombolytic-treated STEMIs in the RCA distribution were associated with lower in-hospital all-cause mortality, cardiogenic shock, and shorter LOS. Mechanical complications were not different based on coronary distribution.
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Affiliation(s)
- Kristina Gifft
- Department of General Medicine, University of Missouri Health Care, Columbia, MO, USA
| | - Mary Dohrmann
- Division of Cardiovascular Medicine, University of Missouri Health Care, Columbia, MO, USA
| | - Mohammad Eniezat
- Medical School of Jordan University of Science and Technology, Irbid, Jordan
| | - Tariq Enezate
- Division of Cardiovascular Medicine, University of Missouri Health Care, Columbia, MO, USA.
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Marquis-Gravel G, Thiele H, Jones WS, Smalling RW, Cohen M, Perera D, Pijls N, Fanaroff A, Brucker A, Chiswell K, Patel MR, Ohman EM. Size of Anterior Wall Acute Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention in United States Versus Europe/Australia Versus India (from the CRISP-AMI Randomized Controlled Trial). Am J Cardiol 2019; 123:1026-1034. [PMID: 30642606 DOI: 10.1016/j.amjcard.2018.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/20/2018] [Accepted: 12/26/2018] [Indexed: 12/31/2022]
Abstract
International variability in infarct size following acute anterior ST-elevation myocardial infarction without shock treated with primary percutaneous coronary intervention (PCI) has been little studied. Patients enrolled in the Counterpulsation to Reduce Infarct Size pre-PCI for Acute Myocardial Infarction international randomized trial were analyzed according to their region of enrollment: United States (US) (n = 60), Europe/Australia (EU/AU) (n = 104), or India (n = 123). Cardiac magnetic resonance imaging was performed 3-5 days after PCI to assess infarct size, expressed as percentage of left ventricular mass, and analyzed by an imaging core laboratory. The relation between infarct size and region was modelled using multivariable linear regression adjusting for time from symptom onset to first hospital contact, myocardial infarction severity, and baseline characteristics. Infarct size was 36.4% of left ventricular mass in US patients (95% confidence interval [CI] 31.5 to 41.4), 36.5% (95% CI 32.6 to 40.4) in EU/AU patients, and 44.7% (95% CI 41.1 to 48.2) in patients from India (p = 0.01). In multiplicity-adjusted regression analysis, mean infarct size in patients from India was higher than in US patients (mean difference of 8.3%; 95% CI 0.7 to 15.8; p = 0.03), and EU/AU patients (mean difference of 8.2%; 95% CI 1.6 to 14.8; p = 0.01). There was no significance difference in infarct size between patients from the EU/AU and the US (mean difference of 0.1%; 95% CI -7.5 to 7.4; p = 0.99). ln conclusion, in patients with anterior ST-elevation myocardial infarction without cardiogenic shock treated with primary PCI, infarct size was larger in India compared to the United States and EU/AU, even after adjustment for performance metrics, including time to treatment, and other potential confounders. Future studies are needed to better elucidate this discrepancy.
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Affiliation(s)
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - W Schuyler Jones
- Duke Clinical Research Institute, Durham, North Carolina; Duke University Medical Center, Durham, North Carolina
| | - Richard W Smalling
- Memorial Hermann Heart and Vascular Institute, University of Texas, Houston, Texas
| | - Marc Cohen
- Newark Beth Israel Medical Center, Newark, New Jersey
| | | | - Nico Pijls
- Catherina Hospital, Eindhoven, the Netherlands
| | | | - Amanda Brucker
- Duke Clinical Research Institute, Durham, North Carolina
| | - Karen Chiswell
- Duke Clinical Research Institute, Durham, North Carolina
| | - Manesh R Patel
- Duke Clinical Research Institute, Durham, North Carolina; Duke University Medical Center, Durham, North Carolina
| | - E Magnus Ohman
- Duke Clinical Research Institute, Durham, North Carolina; Duke University Medical Center, Durham, North Carolina.
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Huang J, Peng X, Fang Z, Hu X, Zhou S. Risk assessment model for predicting ventricular tachycardia or ventricular fibrillation in ST-segment elevation myocardial infarction patients who received primary percutaneous coronary intervention. Medicine (Baltimore) 2019; 98:e14174. [PMID: 30681585 PMCID: PMC6358344 DOI: 10.1097/md.0000000000014174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 12/14/2018] [Accepted: 12/28/2018] [Indexed: 12/02/2022] Open
Abstract
Ventricular tachycardia/ventricular fibrillation (VT/VF) is a kind of malignant arrhythmia in ST-segment elevation myocardial infarction (STEMI) patients who received primary percutaneous coronary intervention (PPCI). However, there are no risk assessment tools to anticipate the occurrence of VT/VF.This study is to build a risk assessment model to predict the possibility of VT/VF onset in STEMI patients undergoing PPCI.A retrospective study was conducted to analyze the patients who underwent PPCI from January 2006 to May 2015. Subjects were divided into VT/VF group and no VT/VF group based on whether VT/VF had occurred or not. In addition, the VT/VF group was further separated into early-onset group (from the time that symptoms began to before the end of PPCI) and late-onset group (after the end of PPCI) based on the timing of when VT/VF happened. Multivariate regression analysis was carried out to distinguish the independent risk factors of VT/VF and an additional statistical method was executed to build the risk assessment model.A total of 607 patients were enrolled in this study. Of these patients, 67 cases (11%) experienced VT/VF. In addition, 91% (61) of patients experienced VT/VF within 48 h from the time that the symptoms emerged. Independent risk factors include: age, diabetes mellitus, heart rate, ST-segment maximum elevation, ST-segment total elevation, serum potassium, left ventricular ejection fraction (LVEF), culprit artery was right coronary artery, left main (LM) stenosis, Killip class > I class, and pre-procedure thrombolysis in myocardial infarction (TIMI) flow zero grade. Risk score model and risk rank model have been established to evaluate the possibility of VT/VF. Class I: ≤ 4 points; Class II: > 4 points, ≤ 5.5 points; Class III: > 5.5 points, < 6.5 points; and Class IV ≥ 6.5 points. The higher the class, the higher the risk.The incidence of VT/VF in STEMI patients undergoing PPCI is 11% and it occurs more frequently from the time that symptoms begin to before the end of PPCI, which, in most cases, occurs within 48 h of the event. Our risk assessment model could predict the possible occurrence of VT/VF.
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Benjamin B, Dyna D, Francy L. Correlation between the diagnostic accuracy of the electrocardiogram and coronary angiography in localization of occluded artery in acute ST-elevation myocardial infarction: A single-center experience. HEART INDIA 2019. [DOI: 10.4103/heartindia.heartindia_20_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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De Gennaro L, Brunetti ND, Ruggiero M, Rutigliano D, Locuratolo N, Di Biase M, Caldarola P. ST-depression in right precordial leads with inferior STEMI and occluded right coronary artery: intertwined anatomy and ischemic areas. Acta Clin Belg 2017; 72:340-342. [PMID: 27774856 DOI: 10.1080/17843286.2016.1246097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Right coronary artery (RCA) occlusion in inferior acute myocardial infarction is usually heralded by ST-elevation both in inferior and in right precordial leads. We report the case of a 68-year-old male, who presented marked ST-elevation in inferior leads, mirrored by ST-depression in anterior-septal and lateral leads. Right precordial lead electrocardiogram unexpectedly showed ST-depression V1R-V5R leads. Coronary angiography showed mid-left anterior descending (LAD) coronary near-complete occlusion with distal wrapping LAD. Left circumflex artery was not occluded, while RCA was occluded mid tract. The patient was treated with coronary angioplasty on RCA and LAD. Absence of ST-elevation in right precordial leads may be presumably explained by the presence of a large ischemic area distal to mid-LAD near-occlusive stenosis and of a long-wrapping LAD. Complex coronary anatomy and intertwined ischemic areas may underlie apparently discording electrocardiograms.
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Sanaani A, Yandrapalli S, Jolly G, Paudel R, Cooper HA, Aronow WS. Correlation between electrocardiographic changes and coronary findings in patients with acute myocardial infarction and single-vessel disease. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:347. [PMID: 28936441 DOI: 10.21037/atm.2017.06.33] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Correlation of ST-segment elevation on the 12-lead electrocardiogram (ECG) with the expected affected coronary territory is established in patients with ST-elevation myocardial infarction (STEMI). In patients with non-ST-elevation myocardial infarction (NSTEMI), correlation of ischemic ECG abnormalities with the affected coronary territory has not been well-established. We sought to investigate the correlation of electrocardiographic abnormalities with the location of 1-vessel obstructive coronary artery disease (CAD) in patients with both STEMI and NSTEMI. METHODS In this retrospective study, the charts of all patients referred for coronary angiography in 2012 were reviewed. Patients with a single obstructive coronary artery plus angina-equivalent symptoms and an elevated cardiac troponin I was included. Available ECGs were interpreted by an experienced cardiologist (WSA) blinded to the result of angiography. Patients with complete bundle branch block or ventricular pacing were excluded. Ischemic ECG changes were correlated to a coronary territory based on predefined criteria. RESULTS Of 131 included patients (mean age 64±13 years; 74% male), 29 had STEMI and 102 had NSTEMI. Eleven of 11 patients (100%) with anterior STEMI had left anterior descending artery (LAD) obstructive CAD. Of 18 patients with inferior STEMI, 14 (78%) had right coronary artery (RCA) obstructive CAD, 3 (17%) had left circumflex artery (LCX) artery obstructive CAD, and 1 (5%) had LAD obstructive CAD. Of 102 NSTEMI patients, 53 (52%) had definite ECG ischemic abnormalities. Of 31 patients with anterior definite ECG ischemic abnormalities, 30 (97%) had LAD obstructive CAD, and 1 (3%) had RCA obstructive CAD. Of 22 patients with inferior definite ECG ischemic abnormalities, 14 (64%) had RCA obstructive CAD, 5 (23%) had LCX obstructive CAD, and 3 (14%) had LAD obstructive CAD. CONCLUSIONS Patients with anterior STEMI had LAD obstructive CAD. Patients with inferior STEMI were highly likely to have RCA or LCX obstructive CAD. Only half of NSTEMI patients had definite ischemic ECG abnormalities. When present, anterior ischemic ECG changes in patients with single vessel CAD with NSTEMI were predictive of LAD obstructive CAD.
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Affiliation(s)
- Abdallah Sanaani
- Division of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Srikanth Yandrapalli
- Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - George Jolly
- Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Rajiv Paudel
- Heart and Vascular Institute of Texas, San Antonio, TX, USA
| | - Howard A Cooper
- Division of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Wilbert S Aronow
- Division of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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Frangieh AH, Obeid S, Ghadri JR, Imori Y, D'Ascenzo F, Kovac M, Ruschitzka F, Lüscher TF, Duru F, Templin C. ECG Criteria to Differentiate Between Takotsubo (Stress) Cardiomyopathy and Myocardial Infarction. J Am Heart Assoc 2016; 5:JAHA.116.003418. [PMID: 27412903 PMCID: PMC4937281 DOI: 10.1161/jaha.116.003418] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND ECG criteria differentiating Takotsubo cardiomyopathy (TTC) from mainly anterior myocardial infarction (MI) have been suggested; however, this was in small patient populations. METHODS AND RESULTS Twelve-lead admission ECGs of consecutive 200 TTC and 200 MI patients were compared in dichotomized groups based on the presence or absence of ST-elevation MI (STEMI versus STE-TTC and non-ST elevation MI versus non ST-elevation-TTC). When comparing STEMI and STE-TTC, ST-elevation in -aVR was characteristic of STE-TTC with a sensitivity/specificity of 43% and 95%, positive predictive value (PPV) 91%, and a negative predictive value (NPV) 62% (P<0.001); when ST-elevation in -aVR is accompanied by ST-elevation in inferior leads, sensitivity/specificity were 14% and 98% (PPV was 89% and NPV 52%) (P=0.001), and 12% and 100% when associated with ST-elevation in anteroseptal leads (PPV 100%, NPV 52%) (P<0.001). On the other hand, STEMI was characterized by ST-elevation in aVR (sensitivity/specificity of 31% and 95% P<0.001, PPV 85% and NPV 59%) and ST-depression in V2-V3-V4 (sensitivity/specificity of 24% and 100% P<0.001, PPV 100% and NPV 76%). When comparing non-ST elevation MI and non ST-elevation-TTC, T-inversion in leads I-aVL-V5-V6 had a sensitivity/specificity of 17% and 97% for non ST-elevation-TTC (PPV 83% and NPV 55%) (P<0.001), and ST-elevation in -aVR with T-inversion in any lead was also specific for non ST-elevation-TTC (sensitivity/specificity of 8% and 100%, PPV 100% and NPV 53%) (P=0.006). In non-ST elevation MI patients, the presence of ST-depression in V2-V3 was specific (sensitivity/specificity of 11% and 99%, PPV 91% and NPV 51%) (P=0.01). CONCLUSIONS ECG on admission can differentiate between TTC and acute MI, with high specificity and positive predictive value. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01947621.
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Affiliation(s)
- Antonio H Frangieh
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Jelena-Rima Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Yoichi Imori
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Fabrizio D'Ascenzo
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Marc Kovac
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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Lindow T, Pahlm O, Nikus K. A patient with non-ST-segment elevation acute coronary syndrome: Is it possible to predict the culprit coronary artery? J Electrocardiol 2016; 49:614-9. [PMID: 27212142 DOI: 10.1016/j.jelectrocard.2016.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Indexed: 11/24/2022]
Abstract
In acute coronary syndromes without ST-segment elevation (NSTE-ACS), identification of the culprit artery is, most often, not possible. In this case report, we elaborate on the likelihood of different culprit arteries in a patient with NSTE-ACS. While her symptoms were progressing, typical ECG findings of ischemia in the left coronary territories were diminishing. Instead, dynamic T-wave changes in the inferior leads were present and were most likely postischemic and "reischemic." Although the culprit artery could not be identified with certainty by means of these subtle changes, they correlated well with the findings on angiography and the ECG recorded afterward. This case report demonstrates the importance of analyzing ECG and its temporal changes in conjunction with evolving symptoms.
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Affiliation(s)
- Thomas Lindow
- Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden.
| | - Olle Pahlm
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Kjell Nikus
- Heart Center, Tampere University Hospital and School of Medicine, University of Tampere, Finland
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Demidova MM, Martín-Yebra A, Koul S, Engblom H, Martínez JP, Erlinge D, Platonov PG. QRS broadening due to terminal distortion is associated with the size of myocardial injury in experimental myocardial infarction. J Electrocardiol 2016; 49:300-6. [DOI: 10.1016/j.jelectrocard.2016.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Indexed: 11/27/2022]
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Ayça B, Conkbayır C, Katkat F, Gulsen K, Akin F, Okuyan E, Baskurt M, Okcun B. The relationship between grade of ischemia, success of reperfusion, and type of thrombolytic regimen. Med Sci Monit 2015; 21:716-21. [PMID: 25746841 PMCID: PMC4362488 DOI: 10.12659/msm.892645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study was aimed to determine whether the grade of ischemia can predict the success of reperfusion in patients treated with thrombolytic therapy (TT) for ST elevation myocardial infarction (STEMI). MATERIAL AND METHODS We enrolled 229 consecutive patients with diagnosis of STEMI and receiving TT. Patients were divided into 2 groups--grade 2 ischemia (GI2) and grade 3 ischemia (GI3)--according to initial electrocardiogram (ECG). As TT, fibrin-specific (tissue plasminogen activator (t-PA)) or non-fibrin-specific (streptokinase (SKZ)) regimens were used. Successful reperfusion was defined as >50% resolution of the maximal ST segment on 90-min ECG. We tried to evaluate whether the grade of ischemia could predict the success of reperfusion and if there were any differences in terms of successful reperfusion between different thrombolytic regimens. RESULTS The successful reperfusion rate was significantly higher in GI2 than GI3 (82.4% vs. 64.4% respectively, p=0.002). The success rate was lowest at anterior GI3 (55.8%). Although there was no significant difference between thrombolytic regimens in all groups (p=0.77), t-Pa was superior to SKZ in anterior GI3 (63,6% vs. 30%, p=0.061). In addition, in multivariate analysis, GI and infarct localization were found as independent predictors for successful reperfusion with TT (p=0.006 and p=0.042, respectively). CONCLUSIONS In the current study, we found that GI2 is an independent predictor for successful reperfusion in STEMI treated with TT. Fibrin specific regime should be preferred in anterior GI3.
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Affiliation(s)
- Burak Ayça
- Department of Cardiology, Bağcılar Education and Research Hospital, Bağcılar, Istanbul, Turkey
| | - Cenk Conkbayır
- Department of Cardiology, Near East University, Nicosia, Cyprus
| | - Fahrettin Katkat
- Department of Cardiology, Istanbul University, Cardiology Institution, Haseki, Istanbul, Turkey
| | - Kamil Gulsen
- Department of Cardiology, Near East University, Nicosia, Cyprus
| | - Fatih Akin
- Department of Cardiology, Sıtkı Koçman University, Muğla, Turkey
| | - Ertuğrul Okuyan
- Department of Cardiology, Bağcılar Education and Research Hospital, Bağcılar, Istanbul, Turkey
| | - Murat Baskurt
- Department of Cardiology, Istanbul University, Cardiology Institution, Haseki, Istanbul, Turkey
| | - Barıs Okcun
- Department of Cardiology, Near East University, Nicosia, Cyprus
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Demidova MM, Carlson J, Erlinge D, Platonov PG. Predictors of ventricular fibrillation at reperfusion in patients with acute ST-elevation myocardial infarction treated by primary percutaneous coronary intervention. Am J Cardiol 2015; 115:417-22. [PMID: 25549882 DOI: 10.1016/j.amjcard.2014.11.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 11/07/2014] [Accepted: 11/07/2014] [Indexed: 11/24/2022]
Abstract
Ventricular fibrillation (VF) during reperfusion (rVF) in ST-segment elevation myocardial infarction (STEMI) is an infrequent but serious event that complicates coronary interventions. The aim of this study was to analyze clinical predictors of rVF in an unselected population of patients with STEMI treated with percutaneous coronary intervention (PCI). Consecutive patients with STEMI admitted to a tertiary care hospital for primary PCI from 2007 to 2012 were retrospectively assessed for the presence of rVF. Admission electrocardiograms, stored in a digital format, were analyzed for a maximal ST-segment elevation in a single lead and the sum of ST-segment deviations in all leads. Clinical, electrocardiographic, and angiographic characteristics were tested for associations with rVF using logistic regression analysis. Among 3,724 patients with STEMI admitted from 2007 to 2012, 71 (1.9%) had rVF. In univariate analysis, history of myocardial infarction, aspirin and β-blocker use, VF before PCI, left main coronary artery disease, inferior myocardial infarction localization, symptom-to-balloon time <360 minutes, maximal ST-segment elevation in a single lead >300 μV, and sum of ST-segment deviations in all leads >1,500 μV were associated with increased risk for rVF. In a multivariate analysis, sum of ST-segment deviations in all leads >1500 μV (odds ratio 3.7, 95% confidence interval 1.45 to 9.41, p = 0.006) before PCI remained an independent predictor of rVF. In-hospital mortality was 18.3% in the rVF group and 3.3% in the group without VF (p <0.001), but rVF was not an independent predictor of in-hospital death. In conclusion, the magnitude of ST-segment elevation before PCI for STEMI independently predicts rVF and should be considered in periprocedural arrhythmic risk assessment. Despite higher in-hospital mortality in patients with rVF, rVF itself has no independent prognostic value for prognosis.
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Rinta-Kiikka I, Tuohinen S, Ryymin P, Kosonen P, Huhtala H, Gorgels A, Bayés de Luna A, Nikus K. Correlation of electrocardiogram and regional cardiac magnetic resonance imaging findings in ST-elevation myocardial infarction: a literature review. Ann Noninvasive Electrocardiol 2014; 19:509-23. [PMID: 25201553 DOI: 10.1111/anec.12210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patients with acute ST-elevation myocardial infarction (STEMI) benefit substantially from emergent coronary reperfusion. The principal mechanism is to open the occluded coronary artery to minimize myocardial injury. Thus the size of the area at risk is a critical determinant of the patient outcome, although other factors, such as reperfusion injury, have major impact on the final infarct size. Acute coronary occlusion almost immediately induces metabolic changes within the myocardium, which can be assessed with both the electrocardiogram (ECG) and cardiac magnetic resonance (CMR) imaging. METHODS The 12-lead ECG is the principal diagnostic method to detect and risk-stratify acute STEMI. However, to achieve a correct diagnosis, it is paramount to compare different ECG parameters with golden standards in imaging, such as CMR. In this review, we discuss aspects of ECG and CMR in the assessment of acute regional ischemic changes in the myocardium using the 17 segment model of the left ventricle presented by American Heart Association (AHA), and their relation to coronary artery anatomy. RESULTS Using the 17 segment model of AHA, the segments 12 and 16 remain controversial. There is an important overlap in myocardial blood supply at the antero-lateral region between LAD and LCx territories concerning these two segments. CONCLUSION No all-encompassing correlation can be found between ECG and CMR findings in acute ischemia with respect to coronary anatomy.
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Nikus K, Birnbaum Y, Eskola M, Sclarovsky S, Zhong-Qun Z, Pahlm O. Updated electrocardiographic classification of acute coronary syndromes. Curr Cardiol Rev 2014; 10:229-36. [PMID: 24827799 PMCID: PMC4040874 DOI: 10.2174/1573403x10666140514102754] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 05/28/2013] [Accepted: 01/28/2014] [Indexed: 11/22/2022] Open
Abstract
The electrocardiogram (ECG) findings in acute coronary syndrome should always be interpreted in the context of the clinical findings and symptoms of the patient, when these data are available. It is important to acknowledge the dynamic nature of ECG changes in acute coronary syndrome. The ECG pattern changes over time and may be different if recorded when the patient is symptomatic or after symptoms have resolved. Temporal changes are most striking in cases of ST-elevation myocardial infarction. With the emerging concept of acute reperfusion therapy, the concept ST-elevation/ non-ST elevation has replaced the traditional division into Q-wave/non-Q wave in the classification of acute coronary syndrome in the acute phase. KEYPOINTS In acute coronary syndrome, in addition to the traditional electrocardiographic risk markers, such as ST depression, the 12-lead ECG contains additional, important diagnostic and prognostic information. Clinical guidelines need to acknowledge certain high-risk ECG patterns to improve patient care.
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Affiliation(s)
| | | | | | | | | | - Olle Pahlm
- Heart Center, Tampere University Hospital. Biokatu 6, 33520 Tampere, Finland.
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Lichtenauer M, Schreiber C, Jung C, Beer L, Mangold A, Gyöngyösi M, Podesser BK, Ankersmit HJ. Myocardial infarct size measurement using geometric angle calculation. Eur J Clin Invest 2014; 44:160-7. [PMID: 25266895 DOI: 10.1111/eci.12202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 11/03/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND In basic cardiovascular research focusing on animal models of myocardial infarction (MI), the measurement of infarct size is performed by planimetry of histological sections of the heart. However, in the setting of chronic MI with ongoing changes in ventricular geometry caused by wall thinning and hypertrophy, the scar area tends to become smaller. MATERIALS AND METHODS Here, in this study we compared infarct measurements in tissue sections (of rat and porcine hearts) based on three different calculation approaches, that is, infarct area, infarct lengths and infarct angles utilizing the centroid of the left ventricle using a newly developed calculation approach. RESULTS Infarct sizes from all three measurement approaches showed significant correlation with parameters of cardiac function. However, results derived from area measurements were significantly smaller than those obtained using the other two measurement approaches due to scar thinning (infarct size area: 14·81% ± 1·27 SEM, length: 23·94% ± 2·04 SEM, angle: 24·75% ± 2·13 SEM, P < 0·0001, n = 30). Moreover, results from angle measurements evidenced a much better correlation with parameters of cardiac function in a small animal model of chronic MI (e.g. ejection fraction, angle: r = -0·73; length: r = -0·64; area: r = -0·59, n = 30) as well as in a large animal model of acute MI (angle: r = -0·82; area: r = -0·67, n = 10). CONCLUSIONS We concluded that area-, length- and angle-based measurements can be used to determine the relative infarct size in acute MI models, although an area-based measurement might be less accurate in the setting of chronic MI. Our new method of infarct angle measurement is a reliable and simple way to calculate infarct size compared with conventional measurement approaches.
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Affiliation(s)
- Michael Lichtenauer
- Universitätsherzzentrum Thüringen, Clinic of Internal Medicine I, Department of Cardiology, Friedrich Schiller University Jena, Jena, Germany; Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Vienna, Austria
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Romero D, Ringborn M, Demidova M, Koul S, Laguna P, Platonov PG, Pueyo E. Characterization of ventricular depolarization and repolarization changes in a porcine model of myocardial infarction. Physiol Meas 2012; 33:1975-91. [DOI: 10.1088/0967-3334/33/12/1975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Akoz A, Bayramoglu A, Uzkeser M, Kantarci M, Aksakal E, Emet M. Two questions for Kounis syndrome: can we use magnetic resonance imaging in the diagnosis and does ST elevation correlates with troponin levels? Am J Emerg Med 2012; 30:2086.e5-7. [PMID: 22386343 DOI: 10.1016/j.ajem.2011.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 12/09/2011] [Indexed: 10/28/2022] Open
Abstract
Kounis syndrome (KS) is an acute coronary vasospasm after exposure to an allergen due to mast cell degranulation and existing mediators. Various drugs, conditions, and environmental exposures can cause KS. We presented 2 cases, 1 of whom had taken an antiflu drug (containing paracetamol, pseudoephedrine, and dextromethorphan). His electrocardiogram (ECG) showed inferior ST elevations (2 mm) with normal cardiac biomarkers. His cardiac magnetic resonance imaging showed hypokinesis and myocardial hibernation on apical septum and on the left ventricle. The second patient took a pill of naproxen sodium. The ECG showed 1-mm ST elevation in leads DII, V5, and V6. His troponin was markedly elevated. These cases showed that there seems to be no correlation with ECG and troponin levels in KS. In addition, for patients in whom KS type 1 is expected without troponin elevation, noninvasive cardiac magnetic resonance imaging study seems to be appropriate for the diagnosis of KS.
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Affiliation(s)
- Ayhan Akoz
- Department of Emergency Medicine, Ataturk University Medical Faculty, 25240 Erzurum, Turkey.
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Influence of small caliber coronary arteries on the diagnostic accuracy of adenosine stress cardiac magnetic resonance imaging. Clin Res Cardiol 2010; 100:201-8. [PMID: 20862587 PMCID: PMC3040827 DOI: 10.1007/s00392-010-0229-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Accepted: 09/07/2010] [Indexed: 01/10/2023]
Abstract
Background and aims Positive predictive value (PPV) of adenosine stress cardiac magnetic resonance (CMR) for coronary artery disease (CAD) is unsatisfactory. We investigated the impact of coronary caliber variability on this limitation in CMR performance. Methods and results 206 consecutive patients with myocardial ischemia during CMR and subsequent coronary angiography (CA) were studied. Patients were examined in a 1.5-T scanner. After adenosine infusion, myocardial first-pass sequence using gadolinium-based contrast agent was performed and compared with rest perfusion. CAD was invasively confirmed in 165 [true positive (TP); PPV, 80.1%] and ruled out in 41 patients [false positive (FP)]. TP and FP were comparable for pre-test risk and CMR findings. We found a significant association between FP CMR and the presence of a small caliber coronary vessel (proximal diameter < one standard deviation below the mean) supplying the area of ischemia (chi-square 42.6, p < 0.0001). A small caliber artery ipsilateral to the ischemic region was a predictive parameter for FP versus TP discrimination (ROC area, 0.84 ± 0.04 vs. 0.59 ± 0.05; p < 0.0001). Further increment in diagnostic accuracy was achieved by including proximal ipsilateral/contralateral coronary diameter ratios (ROC area, 0.90 ± 0.03; p < 0.03). Conclusions Small caliber coronary arteries found as normal variations in right-dominant or left-dominant circulation may account for hypoperfusion in the absence of coronary stenosis and thus may cause FP adenosine stress CMR results. Non-invasive assessment of proximal coronary diameters in the vessel supplying the area of ischemia could reduce FP rates, raise the diagnostic accuracy of CMR for CAD and minimize subsequent superfluous CA.
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Zhong-qun Z, Nikus KC. Factors influencing and significance of ST-segment deviation in lead aVR in acute inferior wall ST-elevation myocardial infarction. J Electrocardiol 2010; 43:288-93. [DOI: 10.1016/j.jelectrocard.2010.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Indexed: 12/24/2022]
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Meissner A, Trappe H, de Boer M, Gorgels A, Wellens H. The value of the ECG for decision-making at first medical contact in the patient with acute chest pain. Neth Heart J 2010; 18:301-6. [PMID: 20657675 PMCID: PMC2881346 DOI: 10.1007/bf03091780] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background/Objectives. Rapid risk stratification of the patient with acute chest pain is essential to select the best management. We investigated the value of the ECG at first medical contact to determine size of the ischaemic myocardial area and thereby severity of risk.Methods. In 386 patients with acute chest pain, ECG findings were correlated with the coronary angiogram. Using ST-segment deviation patterns the location of the coronary culprit lesion was predicted and thereby size of the area at risk. Four groups of patients were present. Those with a narrow QRS and a total 12-lead ST-segment deviation score of >/=5 mm (group 1) or =4 mm (group 2); a QRS width of >/=120 ms (group 3), and patients with previous coronary bypass grafting (CABG) or percutaneous coronary intervention (PCI) (group 4).Results. Correct coronary culprit lesion localisation was possible in 84% of the 185 patients in group 1, 40% of the total cohort. Accurate prediction was not possible in most patients in groups 2, 3 and 4, in spite of extensive coronary artery disease in group 3 and 4. Conclusions. Using the 12-lead ECG the size of the myocardial area at risk can be accurately predicted when the total ST-segment deviation score is >/=5 mm, allowing identification of those in need of a PCI. In most patients with bundle branch block, previous CABG or PCI, the ECG can not localise the culprit lesion. This approach simplifies and accelerates decision-making at first medical contact. (Neth Heart J 2010;18:301-6.).
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Affiliation(s)
- A. Meissner
- Marienhospital Herne, Med Klinik II, Ruhr University, Herne, Germany
| | - H.J. Trappe
- Marienhospital Herne, Med Klinik II, Ruhr University, Herne, Germany
| | - M.J. de Boer
- Department of Cardiology, Isala Clinics, Zwolle, the Netherlands
| | - A.P. Gorgels
- Department of Cardiology, Academic Hospital, Maastricht, the Netherlands
| | - H.J. Wellens
- Cardiovascular Research Institute, Maastricht, the Netherlands
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Nikus K, Pahlm O, Wagner G, Birnbaum Y, Cinca J, Clemmensen P, Eskola M, Fiol M, Goldwasser D, Gorgels A, Sclarovsky S, Stern S, Wellens H, Zareba W, de Luna AB. Electrocardiographic classification of acute coronary syndromes: a review by a committee of the International Society for Holter and Non-Invasive Electrocardiology. J Electrocardiol 2010; 43:91-103. [DOI: 10.1016/j.jelectrocard.2009.07.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Indexed: 10/20/2022]
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Chua SK, Shyu KG, Cheng JJ, Liou JY, Lin SC, Hung HF, Lee SH, Chiu CZ, Lo HM. Significance of left circumflex artery-related acute myocardial infarction without ST-T changes. Am J Emerg Med 2010; 28:183-8. [DOI: 10.1016/j.ajem.2008.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 10/06/2008] [Accepted: 11/07/2008] [Indexed: 10/19/2022] Open
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Ruud TS, Nielsen BF, Lysaker M, Sundnes J. A computationally efficient method for determining the size and location of myocardial ischemia. IEEE Trans Biomed Eng 2009; 56:263-72. [PMID: 19342326 DOI: 10.1109/tbme.2008.2009068] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this paper is to introduce a new method for solving the inverse problem of locating ischemic regions in the heart. The electrical activity in the human heart is modeled by the bidomain equations, which can be expanded to compute the potentials on the body surface. The associated inverse problem is to use ECG recordings to gain information about ischemias. We propose an algorithm for doing this, combining the level set method with a simpler minimization problem. Instead of trying to determine the shape, as in the level set method, we simply make the approximation that the ischemia is spherical. The effects of ischemia on the electrical attributes of heart tissue are examined. The new method is tested with computer simulations on synthetic body surface potential maps (BSPMs) in a realistic geometry, using realistic values for the parameters. It is shown to be, in some respects, superior to the level set approach and may be a step toward a practical algorithm useful in medical diagnostics.
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Andersen MP, Terkelsen CJ, Sørensen JT, Struijk JJ. Performance of an ST dipole model for description of ST deviations in myocardial ischemia. J Electrocardiol 2009; 42:462-8. [DOI: 10.1016/j.jelectrocard.2009.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Indexed: 01/04/2023]
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Nielsen BF, Cai X, Sundnes J, Tveito A. Towards a computational method for imaging the extracellular potassium concentration during regional ischemia. Math Biosci 2009; 220:118-30. [PMID: 19520092 DOI: 10.1016/j.mbs.2009.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 05/15/2009] [Accepted: 05/26/2009] [Indexed: 11/19/2022]
Abstract
We investigate the possibility of using body surface potential maps to image the extracellular potassium concentration during regional ischemia. The problem is formulated as an inverse problem based on a linear approximation of the bidomain model, where we minimize the difference between the results of the model and observations of body surface potentials. The minimization problem is solved by a one-shot technique, where the original PDE system, an adjoint problem, and the relation describing the minimum, are solved simultaneously. This formulation of the problem requires the solution of a 5 x 5 system of linear partial differential equations. The performance of the model is investigated by performing tests based on synthetic data. We find that the model will in many cases detect the correct position and approximate size of the ischemic regions, while some cases are more difficult to locate. It is observed that a simple post-processing of the results produces images that are qualitatively very similar to the true solution.
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Affiliation(s)
- Bjørn Fredrik Nielsen
- Center for Biomedical Computing at Simula Research Laboratory, P.O. Box 134, 1325 Lysaker, Norway.
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Predicting the culprit artery in acute ST-elevation myocardial infarction and introducing a new algorithm to predict infarct-related artery in inferior ST-elevation myocardial infarction: correlation with coronary anatomy in the HAAMU Trial. J Electrocardiol 2009; 42:120-7. [PMID: 19167011 DOI: 10.1016/j.jelectrocard.2008.12.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Indexed: 11/20/2022]
Abstract
AIMS The objective of this study is to predict the culprit artery from the electrocardiogram (ECG) by predefined criteria and to compare a new algorithm with a previous one for predicting the culprit artery in inferior ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS In "all-comers" (n = 187) with acute STEMI, with ECG and angiography from the acute phase, the positive and negative predictive values for the prediction of the left anterior descending coronary artery, left circumflex coronary artery, or right coronary artery as the infarct-related artery were 96% and 96%, 65% and 95%, 92% and 97%, respectively. In inferior STEMI (n = 98), positive and negative predictive values to predict the right coronary artery or the left circumflex coronary artery as the culprit artery were 92% and 75% and 75% and 94%, respectively. CONCLUSIONS In "all-comers" with STEMI, the culprit artery could be predicted by ECG criteria with high predictive values. In inferior STEMI, a new algorithm for culprit artery prediction was successfully tested.
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Nikus KC, Birnbaum Y. Symposium on electrocardiogram in myocardial ischemia and infarction. J Electrocardiol 2008; 42:1-5. [PMID: 19004454 DOI: 10.1016/j.jelectrocard.2008.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Indexed: 10/21/2022]
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Kostic MN, Fakhar S, Foxall T, Drakulic BS, Krucoff MW. Evaluation of novel ECG signal processing on quantification of transient ischemia and baseline wander suppression. ACTA ACUST UNITED AC 2007; 2007:2199-202. [PMID: 18002426 DOI: 10.1109/iembs.2007.4352760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The performance assessment of a novel ECG signal processing technology in Fidelity 100 (test) and four modern ECG systems (controls) was conducted. A quantitative evaluation for one control and a test system was done by simultaneous recordings on 54 patients undergoing percutaneous coronary intervention (PCI) and on a biological reference signal from an ECG simulator. A qualitative performance of baseline wander suppression was done on all five systems. The results showed that the Fidelity 100 system provided excellent detection and quantification of transient ischemia and baseline wander suppression.
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Sun TW, Wang LX, Zhang YZ. The value of ECG lead aVR in the differential diagnosis of acute inferior wall myocardial infarction. Intern Med 2007; 46:795-9. [PMID: 17575369 DOI: 10.2169/internalmedicine.46.6411] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To investigate whether the ST changes in the aVR lead on 12-lead ECG can be used to identify infarct-related artery (IRA) in patients with acute inferior myocardial infarction. METHODS The ECG features were studied in 90 patients with acute inferior myocardial infarction where IRA was confirmed by coronary angiography. RESULTS Right coronary artery (RCA) and the left circumflex coronary artery (LCX) were identified as IRA in 70 and 20 patients, respectively. ST depression in aVR > or = 0.1 mV was found in 14 (70%) patients who had LCX as the IRA, and in 4 (5.7%, p<0.001) patients with RCA as IRA. Using ST segment depression > or = 0.1 mV in aVR as a criterion, the sensitivity and specificity in differentiating LCX as IRA was 70.0% and 94.3%, respectively. CONCLUSIONS ST depression in aVR is common in patients with LCX-related acute inferior myocardial infarction. The ST changes in this lead are associated with an excellent specificity and a good sensitivity in differentiating LCX from RCA as the IRA.
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Affiliation(s)
- Tong-Wen Sun
- Department of Emergency Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
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