Correlation of cumulative ST elevation with left ventricular ejection fraction and 30-day outcome in patients with ST elevation myocardial infarction

Background

The electrocardiogram (ECG) is the first and often the only investigation available prior to definitive therapy in patients with ST elevation myocardial infarction (STEMI). A good prognostic marker is the left ventricular ejection fraction (LVEF) on ECG. Our aim was to assess the correlation between ST elevation (STE) in ECG and the LVEF and thereby aid the prognosis of patients with STEMI.

Methods

This was a prospective cohort study of 230 patients with STEMI. A baseline 12-lead ECG was taken to calculate the sum of STE at the J point in all the leads showing elevation. The STE was measured 90 min after revascularization to calculate the ST resolution percentage (STR%). All patients underwent echocardiography, and the LVEF was measured using biplane Simpson's method.

Results

A total of 136 patients with anterior myocardial infarction (MI), 35 with inferior MI, and 59 with inferoposterior MI were included in the study. Mean STE was 13 mm and was significantly higher among patients with anterior MI. There was a good inverse correlation between the STE and the LVEF with a correlation coefficient of -0.64. STR% had a correlation coefficient of 0.59 to the LVEF. A formula was generated to calculate the LVEF based on the STE as follows: LVEF = (37.34 - STE)/0.567. An STE ≥15 mm predicted an LVEF <35% with a sensitivity and specificity of 70%.

Conclusion

The STE and STR% are useful surrogate markers in prognosticating patients irrespective of the type of STEMI.

SEM studies on acanthocephalan parasite, Echinorhynchus veli infecting the fish Synaptura orientalis (Bl & Sch, 1801)

Echinorhynchus veli (George and Nadakal, 1978), an acanthocephalid worm infesting the estuarine flat fish, Synaptura orientalis, was collected from the Veli lake, Kerala. The parasite was recovered from the intestine of the host fish. The detailed surface morphology was studied with the help of scanning electron microscope. The study revealed a cylindrical, medially swollen proboscis with a flat apex, backward directed hooks, each with smooth surface, broad base, pointed tip and an epidermal elevation at the point of insertion. A pair of sensory pits was seen at the base of the proboscis. The neck was well developed with densely packed epidermal micropores. Paired sensory pits were seen at the base of the neck and a collar between it and the trunk. The epidermis of the trunk has microtriches and micropores. The female genital pore was circular, and terminal in an elevated orifice. In male, the copulatory bursa was directed ventrally, with well-defined rim and several sensory papillae.

Right internal jugular vein approach as an alternative in balloon pulmonary valvuloplasty

Transjugular balloon pulmonary valvuloplasty was safely and successfully performed in five patients, two of whom had severe right heart failure. Crossing the stenotic pulmonary valve from the right internal jugular vein was consistently easy and quick. This approach should be considered whenever difficulties are experienced or anticipated in the femoral approach.