777 Prehospital ECG in patients with acute myocardial infarction during the COVID-19 pandemic

Aims Primary percutaneous coronary intervention (PCI) represents the preferred revascularization strategy among patients with acute ST-segment elevation myocardial infarction (STEMI). A decline in the rates of primary PCI has been observed globally during the outbreak of coronavirus disease-19 (COVID-19). Fear of exposure to in-hospital infection has been hypothesized as the main mechanism of this phenomenon, also contributing to a delayed presentation of patients with STEMI. However, a formal assessment of initial electrocardiograms (ECGs) among STEMI patients during the COVID-19 pandemic is still lacking. We therefore compared pre-hospital ECGs of STEMI patients hospitalized in Italy after the first reported case of COVID-19 on 21 February 2020 with data from the same period in 2019 to identifying potential changes between the two periods. Methods and results Prehospital ECGs were obtained from the STEMI care network in the Campania region. Deidentified ECGs were analysed by two expert reviewers who were blinded to date of recording. Pathological Q-waves were defined as a Q-wave with a duration ≥40 ms and/or depth ≥25% of the R-wave in the same lead or the presence of a Q-wave equivalent. These criteria have been shown to be associated with final infarct size at cardiac magnetic resonance. For all conventional STEMI, the timing of STEMI onset was estimated with the Anderson-Wilkins (AW) acuteness score, ranging from 1 (least acute) to 4 (most acute). From 21 February 2020 to 16 April 2020, a total of 3239 pre-hospital ECGs were recorded by the emergency medical system and 167 (5.15%) were classified as STEMI. During the same period in 2019, 3505 pre-hospital ECGs were recorded, and 196 (5.59%) were classified as STEMI. There was no difference between the two study periods in terms of age, gender, type, and location of STEMI (Table 1). Pathological Q-waves were present in 54.5% of ECGs recorded during the COVID-19 period compared with 22.1% of ECGs recorded in the same period in 2019 (risk difference 32.3, 95% confidence intervals [CI]: 21.2–43.5 percentage points). There was also an increase in the mean number of Q-waves during the COVID-19 compared with the control period (1.4 vs. 0.9; P < 0.001). These findings remained similar when QS- and qR complexes were analysed separately. Consistently, the AW score was significantly lower during the COVID-19 period (2.4 vs. 2.8; P < 0.001). Conclusions Prehospital ECGs of STEMI patients during the COVID-19 pandemic presented more frequently with signs of late ischemia compared with the equivalent period in 2019. Approximately, one out of two patients had already pathological Q-waves in the initial ECG. The AW acuteness score is superior to patient history (historical timing) in predicting myocardial salvage and mortality after reperfusion in STEMI patients, thus explaining the higher mortality rate and the increased risk of infarct-related complications observed during the COVID-19 pandemic.

Automatic Detection of Q-T interval in ECG using MATLAB Tool

While measurement of QT prolongation in electrocardiogram (ECG) is important to clinical applications, but it is quite difficult to evaluate the performance of QT measurement algorithms using clinical ECGs because the real values of the Q-point and T-end point changes are usually unknown and is difficult to detect.This research paper deals with the Abnormality Detection and its analysis using MATLAB tool software. In this paper, abnormity which is in concern is known as QT prolongation. Due to prolongation or extention of QT interval in the ECG graph obtained from abnormal patient, known as QT syndrome is caused.For the analysis purpose, Large number of data has been taken from QT database and MIT-BIH database. Some of the other useful data were also obtained from other useful sources such as ECG wave maven. In this paper, we have dealt only with the detection of QT interval and its detection. A MATLAB algorithm has been generated which in turns detect the Q-wave and T-end point corresponding to its input samples.This algorithm is designed and analyzed with more than 100 samples taken from the various data base sources. It detects onset of the Q-wave and T-end point which in turn is used to calculate QT interval of the analyzed ECG sample.

Evaluation of Serum Level of Interleukin 1 in Patients Suffering from Acute Coronary Syndrome, Admitted to the CCU Ward of AmirAlmomenin Hospital of Zahedan

Background: Atherosclerosis is a disease in which the particles of fat builds up in the blood vessel’s walls. This build up leads to blood flow blockage or can cause the arteries to narrow, but until the stenosis of the vessel is not more than 70 percent, there won’t be any obvious symptoms. Symptoms are dependent on the location of the stenosis that can bring about diseases such as, Unstable Angina (UA), Myocardial Infarction with Q Wave (MIQW) and Non Q Wave (NMIQW). The most common causes of death in most developed countries is Coronary Artery Disease (CAD), and since the inflammatory factors are one of the causes of these diseases, we decided to evaluate the level of the Interleukin-1 (IL-1) in patients with acute coronary syndrome. Methods: 90 patients, suffering from the acute coronary syndrome were selected, which were previously diagnosed and referred to a cardiologist in the Imam Ali Ebneh hospital’s cardiac ward, in 2011. Five ml of periphery blood was obtained from each patient, after 24 hours of hospitalization. Using the ELISA method, the level of interleukin-1 was measured in the three groups of patients, each with symptoms of UA, MIQW and MINQW. Results: Our findings, showed the highest level of interleukin-1 in the MIQW patients, with the average of 46.55 pg/ml and, the lowest level in the MINQW patients, with the average of 28.17 pg/ml. Moreover, the average level of IL-1 in the patient’s serum with UA, is determined equal to 31.28 pg/ml. Although, there was no significant correlations between the type of MI development and UA, there was a significant correlation between the level of IL-1 and the type of MI development. Conclusion: Despite the fact, that the level of IL-1 was higher than normal in all the group types, and no significant correlation between the type of MI development and UA was found, there was statistically a significant correlation between the types of MI development and the level of IL-1.

Long-Term Clinical Impact of Intravascular Ultrasound Guidance in Stenting for Left Main Coronary Artery Disease

Background: Compared with angiographic guidance, intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) is associated with better clinical outcomes. However, its very long-term clinical effect is still unclear in patients undergoing PCI for unprotected left main coronary artery disease. Methods: To compare 10-year outcomes of IVUS-guided versus angiography-guided PCI for left main coronary artery disease, we evaluated 975 patients who underwent unprotected left main coronary artery PCI between January 2000 and June 2006 from the MAIN-COMPARE (The Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) registry. The 10-year rates of clinical outcomes (death; the composite of death, Q-wave myocardial infarction [MI], or stroke; and target-vessel revascularization) were compared between IVUS guidance and angiography guidance. Adjusted analyses were performed with the use of inverse-probability-treatment-weighting and propensity score matching. Results: Among the 975 patients, 756 (77.5%) had IVUS guidance. The observed 10-year incidence rate of death (16.4% versus 31.0%, P <0.001) and composite of death, Q-wave MI, or stroke (19.2% versus 32.9%, P <0.001) was significantly lower in the IVUS-guided than in the angiography-guided group. The 10-year incidence rate of target-vessel revascularization was similar between the 2 groups (21.8% versus 18.3%, P =0.41). After adjusting for potential confounders with inverse-probability-treatment-weighting, IVUS was associated with lower incidence of mortality (hazard ratio, 0.75 [95% CI, 0.55–1.03]; P =0.07) and composite of death, Q-wave MI, or stroke (hazard ratio, 0.79 [95% CI, 0.59–1.06]; P =0.11). In 208 propensity score–matched pairs, IVUS was also associated with lower incidence of death (hazard ratio, 0.73 [95% CI, 0.53–1.02]; P =0.07) and composite outcome of death, Q-wave MI, or stroke (hazard ratio, 0.71 [95% CI, 0.52–0.97]; P =0.03). The benefit of IVUS-guided PCI was consistent in the various subsets of clinical and anatomic characteristics. Conclusions: In patients undergoing PCI for unprotected left main coronary artery disease, IVUS-guided PCI compared with angiography-guided PCI was associated with lower long-term (10-year) risks of morality and composite of death, Q-wave MI, or stroke. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02791412.

NOT EVERY Q WAVE IS AN INFARCT- STEPWISE APPROACH IN A CASE OF CARDIAC AMYLOIDOSIS

We are presenting a case of 65 years old lady who presented in clinic with shortness of breath, pedal and periorbital swelling and lethargy for 1 month. Her initial electrocardiogram (ECG) raised the suspicious of a missed myocardial infarction but detailed workup confirm the diagnosis of multiple myeloma with cardiac amyloidosis. The case highlight the importance of considering differentials of various ECG pattern mimicking infarcts and correlating them clinically and with other diagnostic modalities.

Gender peculiarities of clinical and instrumental indexes in patients with acute Q-wave myocardial infarction after primary coronary intervention

The aim: to determine gender differences in the course of acute Q-wave myocardial infarction in patients after primary coronary intervention. Materials and methods. Results of clinical and instrumental examination of 58 patients with acute Q-wave myocardial infarction were analyzed. Patients were divided into 2 groups according to gender: group 1 (n = 33) – men, mean age 61.0 (55.0; 69.0) years, group 2 (n = 25) – women, mean age 69.0 (63.0; 78.0) years. All the patients underwent coronary angiography followed by angioplasty and stenting of the infarct-dependent coronary artery. Results. In men, the number of leukocytes was significantly higher (by 24.7 %, P = 0.02) and the plasma level of low-density lipoproteins was significantly lower (by 30.9 %, P = 0.007), there was a tendency towards a higher concentration of creatine kinase-MB (by 41.0 %, P = 0.11) at the time of hospital admission as compared to women. Women showed significantly increased thickness of the posterior wall of the left ventricle (LV) (by 7.31 %, P = 0.02) and a tendency towards the prevalence of the interventricular septum wall thickness (by 7.46 %, P = 0.1). The LV end-diastolic and end-systolic dimensions tended to prevail in men (by 2.41 %, P = 0.47 and by 7.81 %, P = 0.19, respectively). Men were found to have a lower peak A rate (by 23.37 %, P = 0.007), a higher E/A ratio (by 52.27 %, P = 0.009), LV diastolic dysfunction (DD) occurred less frequently (χ2 = 2.89, P = 0.08), and there was a tendency to develop eccentric LV hypertrophy (χ2 = 2.39, P = 0.12) and type 2 LV DD (χ2 = 3.82, P = 0.07). Type 1 DD was more common in women (χ2 = 5.71, P = 0.02). In men, there was a tendency to the formation of zones of LV akinesia (χ2 = 2.5, P = 0.09) and decreased LV ejection fraction (χ2 = 1.57, P = 0.31). Conclusions. In the acute period of Q-wave myocardial infarction after revascularization, in men, unlike in women, systolic dysfunction is developed more often. It is accompanied by acute left ventricular failure, eccentric left ventricular hypertrophy and type 2 diastolic dysfunction formation as well as signs of systemic inflammation. In women, in the acute period of Q-wave myocardial infarction after revascularization, concentric left ventricular remodeling occurs more frequently and is accompanied by type 1 left ventricular diastolic dysfunction.

The added value of the electrocardiogram in Noonan syndrome

Noonan syndrome is a genetic disorder characteried by short stature, typical facial features, developmental delay, and CHD. In this single-centre retrospective study, we analysed typical Noonan syndrome-related electrocardiographic features in 95 patients with clinically and molecularly confirmed Noonan syndrome. Typical Noonan syndrome-related electrocardiographic features are left axis deviation, small left precordial R-waves, large right precordial S-waves, abnormal Q-wave, and abnormal wide QRS complex. In this representative cohort, CHD was found in 59 patients (62.1%) and typical Noonan syndrome-related electrographic features in 60 patients (63.2%). The typical Noonan syndrome-related electrographic features were also increased over baseline in patients without CHD (41.7%). Of all 95 patients, left axis deviation was seen in 46.3%, small left precordial R-waves in 30.5%, large right precordial S-waves in 5.3%, and abnormal Q-wave and wide QRS complex in 2.1%. There was no significant difference in the frequency of the individual-specific electrographic features between the group with CHD and the group without CHD. However, there were significantly more patients with a small left precordial R-wave in the subgroup with pulmonary stenosis compared to patients without pulmonary stenosis. Conclusion: Specific Noonan syndrome-related electrographic features are frequently present in patients with Noonan syndrome, also in the absence of CHD. These results suggest that there may be a continuum of cardiac anomalies from overt CHD to milder abnormalities that are only seen on electrocardiogram.

Genetic and nongenetic factors in assessing the prognosis of patients after myocardial infarction with high medical adherence

Aim. During one-year follow-up, to assess the effect of genetic and nongenetic factors on the risk of poor outcomes in patients after myocardial infarction (MI) with high medical adherence.Material and methods. The study included 250 patients admitted to the hospital due to MI in the period from September 1, 2018 to May 1, 2019 and with a potentially high medical adherence. Twelve months after MI, patients were assessed for adherence to therapy and the effect of genetic and nongenetic factors on the patient prognosis.Results. Within 12 months after MI, 70 (28,0%) patients had a composite endpoint: all-cause death, MI, cerebral stroke, and nonelective coronary revascularization. There were following factors increasing the risk of composite endpoint: non-Q-wave MI (relative risk (RR), 2,63; 95% confidence interval (CI): 1,63-4,25 (p=0,001); left ventricular ejection fraction ≤35% — RR, 2,03; 95% CI: 1,17-3,50 (p<0,0001); CYP2C19 GA/AA genotype (RR, 1,58; 95% CI: 1,06-2,37 (p<0,00001)).Conclusion. The study results allow identifying patients with a high risk of poor outcome: patients with non-Q-wave MI, left ventricular ejection fraction ≤35%, and CYP2C19 GA/AA genotype.