scholarly journals Assessment of Selected Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction

2021 ◽  
Vol 10 (22) ◽  
pp. 5445
Author(s):  
Tomasz Fabiszak ◽  
Michał Kasprzak ◽  
Marek Koziński ◽  
Jacek Kubica
Keyword(s):  
Myocardial Infarction ◽  
Regression Analysis ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Qrs Duration

Objective: To assess the performance of ten electrocardiographic (ECG) parameters regarding the prediction of left ventricular systolic dysfunction (LVSD) after a first ST-segment-elevation myocardial infarction (STEMI). Methods: We analyzed 249 patients (74.7% males) treated with primary percutaneous coronary intervention (PCI) included into a single-center cohort study. We sought associations between baseline and post-PCI ECG parameters and the presence of LVSD (defined as left ventricular ejection fraction [LVEF] ≤ 40% on echocardiography) 6 months after STEMI. Results: Patients presenting with LVSD (n = 52) had significantly higher values of heart rate, number of leads with ST-segment elevation and pathological Q-waves, as well as total and maximal ST-segment elevation at baseline and directly after PCI compared with patients without LVSD. They also showed a significantly higher prevalence of anterior STEMI and considerably wider QRS complex after PCI, while QRS duration measurement at baseline showed no significant difference. Additionally, patients presenting with LVSD after 6 months showed markedly more severe ischemia on admission, as assessed with the Sclarovsky-Birnbaum ischemia score, smaller reciprocal ST-segment depression at baseline and less profound ST-segment resolution post PCI. In multivariate regression analysis adjusted for demographic, clinical, biochemical and angiographic variables, anterior location of STEMI (OR 17.78; 95% CI 6.45–48.96; p < 0.001), post-PCI QRS duration (OR 1.56; 95% CI 1.22–2.00; p < 0.001) expressed per increments of 10 ms and impaired post-PCI flow in the infarct-related artery (IRA; TIMI 3 vs. <3; OR 0.14; 95% CI 0.04–0.46; p = 0.001) were identified as independent predictors of LVSD (Nagelkerke’s pseudo R2 for the logistic regression model = 0.462). Similarly, in multiple regression analysis, anterior location of STEMI, wider post-PCI QRS, higher baseline number of pathological Q-waves and a higher baseline Sclarovsky-Birnbaum ischemia score, together with impaired post-PCI flow in the IRA, higher values of body mass index and glucose concentration on admission were independently associated with lower values of LVEF at 6 months (corrected R2 = 0.448; p < 0.00001). Conclusions: According to our study, baseline and post-PCI ECG parameters are of modest value for the prediction of LVSD occurrence 6 months after a first STEMI.

scholarly journals Identification of High-Risk Patients with Non-ST Segment Elevation Myocardial Infarction using Strain Doppler Echocardiography: Correlation with Cardiac Magnetic Resonance Imaging

2016 ◽  
Vol 10 ◽  
pp. CMC.S35734 ◽  
Author(s):  
Mohamed Loutfi ◽  
Sanaa Ashour ◽  
Eman El-Sharkawy ◽  
Sara El-Fawal ◽  
Karim El-Touny
Keyword(s):  
Myocardial Infarction ◽  
Regression Analysis ◽  
Cardiac Magnetic Resonance ◽  
High Risk ◽  
Magnetic Resonance ◽  
Infarct Size ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Assessment of left ventricular (LV) function is important for decision-making and risk stratification in patients with acute coronary syndrome. Many patients with non-ST segment elevation myocardial infarction (NSTEMI) have substantial infarction, but these patients often do not reveal clinical signs of instability, and they rarely fulfill criteria for acute revascularization therapy. Aim This study evaluated the potential of strain Doppler echocardiography analysis for the assessment of LV infarct size when compared with standard two-dimensional echo and cardiac magnetic resonance (CMR) data. Methods Thirty patients with NSTEMI were examined using echocardiography after hospitalization for 1.8 ± 1.1 days for the assessment of left ventricular ejection fraction, wall motion score index (WMSI), and LV global longitudinal strain (GLS). Infarct size was assessed using delayed enhancement CMR 6.97 ± 3.2 days after admission as a percentage of total myocardial volume. Results GLS was performed in 30 patients, and 82.9% of the LV segments were accepted for GLS analysis. Comparisons between patients with a complete set of GLS and standard echo, GLS and CMR were performed. The linear relationship demonstrated moderately strong and significant associations between GLS and ejection fraction (EF) as determined using standard echo ( r = 0.452, P = 0.012), WMSI ( r = 0.462, P = 0.010), and the gold standard CMR-determined EF ( r = 0.57, P < 0.001). Receiver operating characteristic curves were used to analyze the ability of GLS to evaluate infarct size. GLS was the best predictor of infarct size in a multivariate linear regression analysis (β = 1.51, P = 0.027). WMSI >1.125 and a GLS cutoff value of −11.29% identified patients with substantial infarction (≥12% of total myocardial volume measured using CMR) with accuracies of 76.7% and 80%, respectively. However, GLS remained the only independent predictor in a multivariate logistic regression analysis to identify an infarct size ≥12%. Conclusion GLS is a good predictor of infarct size in NSTEMI, and it may serve as a tool in conjunction with risk stratification scores for the selection of high-risk NSTEMI patients.

scholarly journals EFFECT OF PREHOSPITAL SYSTEMIC THROMBOLYSIS ON LEFT VENTRICULAR SYSTOLIC DYSFUNCTION IN ST-SEGMENT ELEVATION ACUTE MYOCARDIAL INFARCTION

2021 ◽  
Vol 14 (3) ◽  
Author(s):  
A Alavi ◽  
S Kenzhaev ◽  
I Kakharov
Keyword(s):  
Standard Therapy ◽  
Left Ventricular Systolic Dysfunction ◽  
Myocardial Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Control Group ◽  
Ventricular Systolic Dysfunction ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Objective: to study the effect of prehospital thrombolysis on left ventricular systolic dysfunction in patients with acute ST-segment elevation coronary syndrome.Material and methods: The study included 70 patients with acute coronary syndrome with ST-segment elevation. Patients were randomized into two groups: control (group A) - 35 patients receiving standard therapy, and hospital TLT. Group B included 35 patients who underwent standard therapy and prehospital TLT. All 70 patients underwent echocardiography 1 day after myocardial revascularization and 3 months later.Results: the use of early myocardial reperfusion in patients with STEMI had a positive effect on central hemodynamics, reduced the development of LV volume overload, as a result of which end-diastolic and systolic volumes did not change during 3 months of follow-up. LVEF grew in both groups, and its growth was more pronounced in group B.Conclusion: timely prehospital reperfusion reduces the severity of myocardial damage and thus prevents the development of severe systolic myocardial dysfunction LV.

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