scholarly journals Posterior wall involvement attenuates predictive value of ST-segment elevation in lead V4R for right ventricular involvement in inferior acute myocardial infarction

2009 ◽  
Vol 54 (3) ◽  
pp. 386-393 ◽  
Author(s):  
Masami Kosuge ◽  
Toshiyuki Ishikawa ◽  
Satoshi Morita ◽  
Toshiaki Ebina ◽  
Kiyoshi Hibi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Right Ventricular ◽  
Predictive Value ◽  
Posterior Wall ◽  
St Segment Elevation ◽  
St Segment ◽  
Inferior Acute Myocardial Infarction

Abstract 552: Posterior Involvement Attenuates Predictive Value of ST-Segment Elevation in Lead V4R for Right Ventricular Involvement in Inferior Acute Myocardial Infarction

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Masami Kosuge ◽  
Kazuo Kimura ◽  
Toshiaki Ebina ◽  
Kiyoshi Hibi ◽  
Kengo Tsukahara ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Right Ventricular ◽  
Myocardial Reperfusion ◽  
Total Occlusion ◽  
St Segment Elevation ◽  
St Segment ◽  
Inferior Acute Myocardial Infarction ◽  
The Right ◽  
The Impact

ST-segment elevation (ST ↑) ≥1.0 mm in lead V4R is considered a reliable marker of right ventricular involvement (RVI) in inferior acute myocardial infarction (IMI). However, the impact of posterior involvement (PI) on the relation between RVI and ST ↑ in lead V4R is unknown. We studied 267 patients with a first IMI who had total occlusion and TIMI 3 flow of the right coronary artery within 6 h after the onset. A 12-lead ECG, lead V4R, and leads V7–9 were recorded on admission. RVI was defined as occlusion proximal to the first right ventricular branch. The perfusion territory was assessed by angiographic distribution score, and PI was defined as a score of ≥0.7. Myocardial blush grade was assessed immediately after reperfusion. Patients were stratified according to the presense or absense of PI and RVI. Times to admission and reperfusion were similar in the 4 groups. RVI was associated with higher peak creatine kinase and higher rates of impaired myocardial reperfusion (blush grade 0/1) and congestive heart failure during hospitalization in the presense or absense of PI, especially the former. RVI was associated with a higher rate of ST ↑ in lead V4R in the absence, but not in the presence, of PI. ST ↑ in lead V4R identified RVI with sensitivities of 34% and 96% (p<0.001) and specificities of 83% and 82% (NS) in the presence and absence of PI, respectively. In patients with reperfused IMI, RVI is associated with a larger infarct size and impaired myocardial reperfusion. However, the incidence of RVI diagnosed by ST ↑ in lead V4R was underestimated in the presence of posterior involvement. ST ↑ in lead V4R caused by RVI might be attenuated due to a reciprocal change in posterior ST ↑.

scholarly journals Implications of the absence of st-segment elevation in lead V4Rin patients who have inferior wall acute myocardial infarction with right ventricular involvement

2001 ◽  
Vol 24 (3) ◽  
pp. 225-230 ◽  
Author(s):  
Masami Kosuge ◽  
Kazuo Kimura ◽  
Toshiyuki Ishikawa ◽  
Yoichiro Hongo ◽  
Tomohiko Shigemasa, ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Right Ventricular ◽  
Inferior Wall ◽  
St Segment Elevation ◽  
St Segment

scholarly journals Acute myocardial infarction in patients with syncope

CJEM ◽  
2009 ◽  
Vol 11 (02) ◽  
pp. 156-160 ◽  
Author(s):  
Daniel McDermott ◽  
James V. Quinn ◽  
Charles E. Murphy
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Negative Predictive Value ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
St Segment Elevation ◽  
St Segment ◽  
High Negative Predictive Value

ABSTRACT Objective: We sought to determine the incidence of acute myocardial infarction (AMI) in emergency department (ED) patients with syncope, the characteristics of these AMIs and how helpful the initial electrocardiogram (ECG) was in identifying these cases. Methods: In a prospective cohort of consecutive patients with syncope, the initial ECG was found to be abnormal using a prespecified definition (any nonsinus rhythm or any new or age-indeterminate abnormalities). Patients were then followed up to identify an AMI diagnosed within 30 days of presentation. Results: There were 1474 consecutive patient visits for syncope or near-syncope over a 45-month period spanning from Jul. 1, 2000, to Feb. 28, 2002, and Jul. 15, 2002, to Aug. 31, 2004, of which 46 (3.1%) were diagnosed with AMI. The majority of the AMI patients (42) had no ST segment elevation. The initial ECG was abnormal in 37 out of 46 cases. The diagnostic performance of the initial ECG was sensitivity 80% (95% confidence interval [CI] 67%–89%), specificity 64% (95% CI 61%–67%), negative predictive value 99% (95% CI 98%–100%), positive predictive value 7% (95% CI 6%–8%), positive likelihood ratio 2.2 (95% CI 1.6–2.5) and negative likelihood ratio 0.3 (95% CI 0.2–0.5). Conclusion: The incidence of AMI in patients presenting with syncope is low. A normal ECG has a high negative predictive value, although its sensitivity is limited.

scholarly journals Acute myocardial infarction with ST segment elevation in inferior and anterior leads: right ventricular infarction

2010 ◽  
Vol 2010 (feb02 1) ◽  
pp. bcr0320091700-bcr0320091700
Author(s):  
R. Berent ◽  
J. Auer ◽  
S. von Duvillard ◽  
H. Sinzinger ◽  
D. Steinbrenner ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Right Ventricular ◽  
St Segment Elevation ◽  
Right Ventricular Infarction ◽  
St Segment ◽  
Ventricular Infarction

scholarly journals Compaired Sacubitril/Valsartan with Benalapril on the Left Ventricular Remordeling of Ami after PPCI: A case-control study

2021 ◽  
Vol 3 (1) ◽  
pp. 01-05
Author(s):  
Yanmin XU
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Posterior Wall ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
St Segment ◽  
Control Study ◽  
Motion Amplitude

Background: To compare the effect of sacubitril/valsartan with benalapril on left ventricular remodeling in patients with acute myocardial infarction. Materials and Methods: 85 patients with acute ST segment elevation myocardial infarction who were treated with PCI in the Second Affiliated Hospital of Tianjin Medical University. The patients were randomly divided into two groups: the experimental group (sacubitril/valsartan, 25-100mg/d, BID) and the control group (benalapril, 5-10mg, QD). Color Doppler echocardiography was performed after 1 month and 3 months respectively, interventricular septal thickness, septal motion amplitude, left ventricular end diastolic diameter, left ventricular end systolic diameter, posterior wall thickness, posterior wall motion amplitude, LVEF, left ventricular weight, left ventricular weight index, NT Pro-BNP, gender, height, weight, body surface area were collected. In order to evaluate the influencing factors in the process of ventricular remodeling, binary multivariate logistic regression analysis was carried out for the indicators with statistical differences in the conclusions of the above control study. Subgroup analysis was carried out and the samples were divided into four subgroups according to gender,age, initial ejection fraction . Resulst: one month after the treatment of sacubitril/valsartan or benalapril, only the left ventricular end systolic diameter was statistically different between the two groups (P < 0.05), and the other indexes were not statistically different. Three months after treatment with sacubitril/valsartan or benalapril, there were statistical differences in the indexes related to myocardial remodeling between the two groups (P < 0.05). The results of multivariate logistic analysis showed that the index of left ventricular end systolic diameter was statistically significant (or=0.006, 95% CI: 0.733-0.981). Acute myocardial infarction whose LVEF is less than 50%, show sacubitril/valsartan is better than traditional ACEI. Conclusion: sacubitril/valsartan Compared with benalapril is better on left ventricular remodeling in patients with ST segment elevation acute myocardial infarction.

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