P982 Correlation between electrocardiographic and imaging data in patients with acute myocarditis: a single centre retrospective analysis

Abstract Funding Acknowledgements None Background Acute myocarditis is a clinical and pathological condition defined as an inflammation of the myocardium. Its diagnosis is often challenging and requires multiple information derived from different diagnostic modalities. Purpose The aim of the study is to evaluate the correlation between electrocardiographic and imaging data in patients with acute myocarditis. Methods We made a retrospective analysis of 102 patients admitted to our Centre between January 2012 and April 2019 for suspected acute myocarditis. Diagnosis was confirmed with cardiac magnetic resonance (CMR) by identification of myocardial edema in T2-weighted images and/or typical subepicardial or midwall pattern of late gadolinium enhancement (LGE). Significant coronary artery disease was ruled out with coronary angiography. Electrocardiogram (ECG) was analysed on admission - in order to evaluate the presence of ST segment abnormalities, atrio-ventricular or bundle-branch block and heart rhythm disorders - and at the time of discharge. Every patient underwent echocardiography and CMR: from both these exams we reported the presence of regional wall motion abnormalities and left ventricular ejection fraction (LVEF). Results Mean age of our population was 39 ± 18 years; 92 people (90%) were males. At admission, 85 patients (83%) presented ECG abnormalities; the most frequent was ST-segment elevation (65 cases). Conduction or rhythm disorders were observed in 26 cases (25%). At the time of discharge, 41 out of 85 patients had complete regression of ECG changes. Mean value of LVEF measured with echocardiography was 56.4 ± 7.6%. In patients with normal ECG on admission it was 59.9 ± 3.1%, whereas in patients with abnormal ECG 55.7 ± 7.9% (p = 0.045). Considering CMR, mean LVEF in the population was 58.5 ± 8.6%, varying between 64.0 ± 8.9% in the group with normal ECG and 57.4 ± 10.1% in the group with ECG abnormalities (p = 0.02). Moreover, subjects with altered ECG on admission had a higher prevalence of wall motion abnormalities both in echocardiography (47/85 – 55% vs 3/17 – 18%, p < 0.01) and in CMR (45/85 – 53% vs 3/17 – 18%, p < 0.01). Patients with ECG normalization at discharge had a higher prevalence of ST-segment elevation (88 vs 66%, p = 0.02), while the group with persistent ECG alterations had a higher incidence of AV or bundle-branch block (23 vs 7%, p = 0.048). No statistical difference was noted between these two groups regarding echocardiographic or CMR values. Conclusion In our experience evaluation of ECG at admission in patients with suspected acute myocarditis identifies a subgroup of individuals with lower values of LVEF and a higher prevalence of wall motion abnormalities both in echocardiography and in CMR, while data derived by imaging techniques had no significant predictive value on ECG evolution at the time of discharge.

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Intraventricular conduction defects in patients with st-segment elevation myocardial infarction – the paradox of right bundle branch block

European Heart Journal ◽

10.1093/ehjci/ehaa946.1615 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Fernandes ◽

F Montenegro ◽

M Cabral ◽

R Carvalho ◽

L Santos ◽

...

Keyword(s):

Hospital Mortality ◽

Right Bundle Branch Block ◽

Independent Predictor ◽

Left Ventricular Ejection ◽

Bundle Branch Block ◽

Hospital Outcomes ◽

St Segment Elevation ◽

Intraventricular Conduction ◽

St Segment ◽

Worse Prognosis

Abstract Intraventricular conduction defects (IVCD) in patients with acute myocardial infarct (AMI) are predictors of a worse prognosis. When acquired they can be the result of an extensive myocardial damage. Purpose To assess the impact of IVCD, regardless of being previously known or presumed new, on in-hospital outcomes of patients with AMI with ST segment elevation (STEMI) or undetermined location. Methods From a series of patients included in the National Registry of Acute Coronary Syndrome between 10/1/2010 and 9/1/2019, were selected patients with STEMI or undetermined AMI, undergoing coronary angiography. Results 7805 patients were included: 461 (5.9%) presenting left bundle branch block (LBBB), 374 (4.8%) with right bundle branch block (RBBB) and 6970 (89.3%) with no IVCD. Clinical characteristics as well as in-hospital outcomes are described in the table 1. An unexpected worse prognosis in patients with RBBB has motivated a multivariate analysis. RBBB remained an independent predictor of in-hospital mortality (OR 1.91, 95% CI 1.04–3.50, p=0.038), along with female gender (OR 1.73, 95% CI 1.11–2.68, p=0.015), Killip Class>1 (OR 2.26, 95% CI 1.45–3.53, p<0.001), left ventricular ejection fraction <50% (OR 3.93, 95% CI 2.19–7.05, p<0.001) and left anterior descending artery as the culprit lesion (OR 1.85, 95% CI 1.16–2.91, p=0.009). Conclusion In spite of an apparent better clinical profile, in the current large series of unselected STEMI patients, the presence of RBBB is associated with the worst in-hospital outcome. RBBB doubles the risk of death, being an independent predictor of in-hospital mortality. Funding Acknowledgement Type of funding source: None

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Role of territorial speckle tracking echocardiography in identifying the localization of significant coronary artery disease in patients with non-ST-segment elevation acute coronary syndromes

European Heart Journal ◽

10.1093/eurheartj/ehab724.019 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

E Gherbesi ◽

G Chiarello ◽

V L Paiocchi ◽

L A Leo ◽

S A Schlossbauer ◽

...

Keyword(s):

Coronary Artery ◽

Wall Motion ◽

Speckle Tracking Echocardiography ◽

St Segment Elevation ◽

Non Invasive ◽

St Segment ◽

Coronary Syndromes ◽

Wall Motion Abnormalities ◽

Artery Disease

Abstract Background In non-ST-segment elevation acute coronary syndromes (NSTE-ACS) patients, several studies demonstrated that 2D speckle tracking echocardiography (STE) is able to predict the presence of coronary artery disease (CAD). Conversely, the role of STE for the localization of significant CAD is less well established. Purpose To investigate the role of territorial longitudinal (TLS) and circumferential strain (TCS) assessed with STE as a non-invasive predictor of localization of significant CAD in patients with NSTE-ACS. Methods We retrospectively enrolled NSTE-ACS patients with significant stenosis (≥70%) at least in one major epicardial coronary artery and without previous cardiovascular events over two years of time. Echocardiography was recorded before coronary angiography and myocardial strain was evaluated offline by an operator blinded to clinical data. Territorial strain was calculated grouping and averaging the strain values of the segments perfused by the 3 major coronary arteries. Results 150 patients were included (age 66.3±11.8 years, 71% male; 90.7% NSTEMI and 9.3% unstable angina). ROC curve analysis demonstrated the ability of TLS and TCS to identify the presence of coronary stenosis of LAD, LCX or RCA (AUC for TLS-LAD 0.74 [0.66–0.82] p=0.0001; LCX 0.73 [0.65–0.81] p=0.0001; RCA 0.69 [0.60–0.77] p=0.0001-AUC for TCS-LAD 0.80 [0.70–0.90] p=0.0001; LCX 0.76 [0.67–0.85] p=0.0001; RCA 0.65 [0.55–0.75] p=0.0001), superior to territorial wall motion score index (Figure 1). The diagnostic value was confirmed in the subgroup of patients without wall motion abnormalities for TLS and for TCS, except for RCA. Conclusion Territorial strain assessed with STE might be a non-invasive tool to localize coronary artery stenosis in patients with NSTE-ACS, even without wall motion abnormalities. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. ROC curve analyses

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Evaluation by quantitative 99m-technetium MIBI SPECT and echocardiography of myocardial perfusion and wall motion abnormalities in patients with dobutamine-induced ST-segment elevation

The American Journal of Cardiology ◽

10.1016/s0002-9149(99)80127-1 ◽

1995 ◽

Vol 76 (7) ◽

pp. 441-448 ◽

Cited By ~ 32

Author(s):

Abdou Elhendy ◽

Marcel L. Geleijnse ◽

Jos R.T.C. Roelandt ◽

Ron T. van Domburg ◽

Jan H. Cornel ◽

...

Keyword(s):

Myocardial Perfusion ◽

Wall Motion ◽

St Segment Elevation ◽

St Segment ◽

Wall Motion Abnormalities ◽

Mibi Spect

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Clinical Presentations and Outcomes in Patients Presenting With Acute Cardiac Events and Right Bundle Branch Block

Angiology ◽

10.1177/0003319719892159 ◽

2019 ◽

Vol 71 (3) ◽

pp. 256-262 ◽

Cited By ~ 1

Author(s):

Fahad Alkindi ◽

Ayman El-Menyar ◽

Ihsan Rafie ◽

Abdulrahman Arabi ◽

Jassim Al Suwaidi ◽

...

Keyword(s):

Myocardial Infarction ◽

Right Bundle Branch Block ◽

Independent Predictor ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Cardiac Events ◽

Bundle Branch Block ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

We conducted a retrospective analysis of 50 974 patients admitted with acute cardiac events with and without right bundle branch block (RBBB) over 23 years. Compared to non-RBBB, patients with RBBB (n = 386; 0.8%) were 3 years older ( P = .001), more likely to present with breathlessness rather than chest pain ( P = .001), and had more diabetes mellitus ( P = .001). Patients with RBBB had significantly higher cardiac enzymes ( P = .001); however, there were no significant differences in the presentation with ST-segment elevation myocardial infarction (24.6% vs 22.2%), non-ST-segment elevation myocardial infarction (23.7% vs 22.4%), and unstable angina (51.7% vs 55.4%). Patients with RBBB were more likely to have congestive heart failure (CHF; 9.6% vs 3.2%, P = .001), cardiogenic shock (10.6% vs 1.7%, P = .001), and ventricular tachyarrhythmias (7.3% vs 2.2%, P = .001). Left ventricular ejection fraction and hospital length of stay were comparable between the groups. All-cause mortality was 5 times greater in patients with RBBB (21% vs 4.2%, P = .001). Right bundle branch block was independent predictor of mortality (adjusted odd ratio 5.14; 95% confidence interval: 3.90-6.70). Subanalysis comparing normal QRS, RBBB, and left BBB showed that RBBB was associated with the worst outcomes except for CHF. Although RBBB presents in only about 1% of patients with cardiac disease, it was found to be an independent predictor of hospital mortality.

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A ‘shark’-masked electrocardiogram: case report of a Tako-Tsubo syndrome

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab132 ◽

2021 ◽

Vol 5 (5) ◽

Author(s):

Monica Verdoia ◽

Orazio Viola ◽

Federica Marrara ◽

Pier Luigi Soldà

Keyword(s):

Wall Motion ◽

Clinical Manifestations ◽

Complete Recovery ◽

Neurological Involvement ◽

St Segment Elevation ◽

Case Summary ◽

Acute Coronary Occlusion ◽

St Segment ◽

Triggering Conditions ◽

Wall Motion Abnormalities

Abstract Background Triangular ST-segment elevation or ‘shark-fin’ sign has been described as a specific indicator of acute coronary occlusion and large myocardial ischaemia, translating into poorer prognosis. However, this electrocardiographic presentation has been reported in rare cases of Tako-Tsubo syndrome and associated with more severe physical stressors and neurological involvement. Case summary We present a rare case of a 51-year-old woman presenting with incoming epileptic attacks and concomitant pyometra. Despite controlling epilepsy with phenytoin and the surgical treatment of the infection, she developed sepsis requiring vasopressors, and thereafter sustained ventricular tachycardia and diffuse ST-segment elevation with the ‘shark-fin’ sign. TTC was confirmed by the documentation of normal coronary arteries and the complete recovery of wall motion abnormalities at discharge. Discussion Heterogeneous presentation and triggering conditions often challenge the diagnosis of Tako-Tsubo syndrome. The acknowledgement of different electrocardiographic and clinical manifestations can ease the diagnosis and the successful management of these patients, whose prognosis can be extremely severe in the acute phase, if unidentified.

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Regional Left Ventricular Wall Motion Abnormalities and Exercise Induced St Segment Elevation in Patients with Recent Myocardial Infarction

Clinical Science ◽

10.1042/cs073039pb ◽

1987 ◽

Vol 73 (s17) ◽

pp. 39P-39P

Author(s):

N. Bishop ◽

A. F. MacKintosh

Keyword(s):

Myocardial Infarction ◽

Wall Motion ◽

Left Ventricular ◽

Ventricular Wall ◽

Left Ventricular Wall Motion ◽

St Segment Elevation ◽

St Segment ◽

Wall Motion Abnormalities ◽

Ventricular Wall Motion ◽

Exercise Induced

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Subaortic (Type 6) Muscular Band—Innocent Bystander or Pathologic Structure?

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s5378 ◽

2010 ◽

Vol 4 ◽

pp. CMC.S5378 ◽

Cited By ~ 2

Author(s):

J Ker

Keyword(s):

Retrospective Analysis ◽

Right Bundle Branch Block ◽

Innocent Bystander ◽

Bundle Branch Block ◽

St Segment Elevation ◽

Cardiac Abnormalities ◽

St Segment ◽

Bundle Of His

Intraventricular tendons are structures that was identified more than a hundred years ago. It has been suggested that they represent intracavitary radiations of the bundle of His and that they may be an isolated finding or be associated with structural cardiac abnormalities. Loukas et al divided these structures into five categories and recently a sixth type have been added. Various physiological disturbances have been observed due to the sixth type of tendon, such as ST segment elevation and right bundle branch block. It has been noted that this peculiar structure appears too thick to be called a tendon, thus the term band. This retrospective analysis analyzed the incidence of the thick, subaortic (type 6) muscular band in a cardiovascular clinic.

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