| 1. |
- Allencherril, Joseph, et al.
(author)
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Correlation of anteroseptal ST elevation with myocardial infarction territories through cardiovascular magnetic resonance imaging
- 2018
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In: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736. ; 51:4, s. 563-568
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Journal article (peer-reviewed)abstract
- Background: Anteroseptal ST elevation myocardial infarction (STEMI) is traditionally defined on the electrocardiogram (ECG) by ST elevation (STE) in leads V1-V3, with or without involvement of lead V4. It is commonly taught that such infarcts affect the basal anteroseptal myocardial segment. While there are suggestions in the literature that Q waves limited to V1-V4 represent predominantly apical infarction, none have evaluated anteroseptal ST elevation territories. We compared the distribution of the myocardium at risk (MaR) in STEMI patients presenting with STE limited to V1-V4 and those with more extensive STE (V1-V6). Methods: We identified patients in the MITOCARE study presenting with a first acute STEMI and new STE in at least two contiguous anterior leads from V1 to V6. Patients underwent cardiac magnetic resonance (CMR) imaging three to five days after acute infarction. Results: Thirty-two patients met inclusion criteria. In patients with STE in V1-V4 (n = 20), myocardium at risk (MaR) > 50% was seen in 0%, 85%, 75%, 100%, and 90% in the basal anteroseptal, mid anteroseptal, apical anterior, apical septal segments, and apex, respectively. The group with STE in V1-V6 (n = 12), MaR > 50% was seen in 8%, 83%, 83%, 92%, and 83% of the same segments. Conclusions: Patients with acute STEMI and STE in leads V1-V4, exhibit MaR in predominantly apical territories and rarely in the basal anteroseptum. We found no evidence to support existence of isolated basal anteroseptal or septal STEMI. “Anteroapical” infarction is a more precise description than “anteroseptal” infarction for acute STEMI patients exhibiting STE in V1-V4.
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| 2. |
- Jia, Xiaoming, et al.
(author)
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Cardiac magnetic resonance evaluation of the extent of myocardial injury in patients with inferior ST elevation myocardial infarction and concomitant ST depression in leads V1-V3 : Analysis from the MITOCARE Study
- 2018
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In: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 140:3, s. 178-185
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Journal article (peer-reviewed)abstract
- The aim of our study was to examine the pathophysiology of ST depression (STD) in leads V1-V3 in the setting of inferior ST elevation myocardial infarction (iSTEMI) through the perspective of cardiac magnetic resonance (CMR). Methods: Differences in myocardial area at risk (MaR), infarct size, ejection fraction and myocardial segment involvement by CMR were compared in MITOCARE trial patients with first iSTEMI with ST elevation (STE), STD or no ST changes (NST) in V1-V3. The frontal plane projection of the inferior wall MaR in relationship to the anterior/posterior chest wall was calculated and compared between groups. Results: Fifty-six patients were included. Patients with STD (n = 38) and STE (n = 5) in V1-V3 had significantly larger mean MaR compared to NST (n = 13; 32 ± 7%LV, 36 ± 10%LV and 26 ± 6%LV, respectively; p = 0.01). STD in leads V1-V3 was associated with more apical inferior and mid inferoseptal involvement and had a larger mean frontal plane projection of MaR compared with NST (24 ± 6%LV vs. 20 ± 6%LV, p = 0.04). Conclusion: STD in V1-V3 in iSTEMI is associated with larger MaR, more extension into the inferoseptal segments and likely results from greater frontal plane projection of the MaR, leading to reciprocal changes on the electrocardiogram.
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| 3. |
- Jia, Xiaoming, et al.
(author)
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Correlation of ST changes in leads V4–V6 to area of ischemia by CMR in inferior STEMI
- 2018
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In: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 52:4, s. 189-195
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Journal article (peer-reviewed)abstract
- Objective. We aim to determine the correlation between ST-segment changes in leads V4–V6 and the extent of myocardial injury by cardiac magnetic resonance (CMR) in patients with inferior ST elevation (STE) myocardial infarction (iSTEMI). Design. Admission electrocardiogram and CMR data from the MITOCARE trial were used. Differences in mean myocardium at risk, infarct size, ejection fraction and myocardial segment involvement by CMR were compared in patients with first iSTEMI with STE, ST depression (STD) or no ST changes (NST) in V4–V6. Myocardial segment involvement was further evaluated by comparing proportion of patients in each group with ≥25% and ≥50% segment involvement. Results. Fifty-four patients were included. Patients with STE (n = 22) and STD (n = 16) in V4–V6 had significantly lower ejection fraction compared to NST (n = 16) (48% vs 48% vs 54%, p = .02). STE showed more apical, apical lateral and mid-inferolateral involvement but less basal inferior involvement than NST. STD exhibited greater basal inferoseptal involvement compared to STE. There were more patients with STE that had ≥25% and ≥50% apical lateral involvement compared with STD and NST groups. Patients with STD were more likely to have ≥25% and ≥50% basal inferoseptal involvement compared with STE and NST groups.Conclusion. Our study suggests that in iSTEMI, ST changes in the precordial leads V4–V6 correlates with greater myocardial injury and distribution of myocardium at risk.
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| 5. |
- Ripa, Rasmus S., et al.
(author)
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Consideration of the total ST-segment deviation on the initial electrocardiogram for predicting final acute posterior myocardial infarct size in patients with maximum ST-segment deviation as depression in leads V1 through V3. A FRISC II substudy
- 2005
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In: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736 .- 1532-8430. ; 38:3, s. 180-6
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Journal article (peer-reviewed)abstract
- BACKGROUND: Because patients with acute left circumflex occlusion are typically characterized primarily on the standard 12-lead electrocardiogram (ECG) by ST depression, they do not qualify to receive reperfusion therapy. Documentation of a relationship between the quantities of acute ST change and final QRS estimated acute myocardial infarction (AMI) size could form the basis for clinical trials to determine the value of reperfusion therapy. METHOD: The Fragmin and Fast Revascularization during Instability in Coronary artery disease trial included 3214 patients with unstable coronary artery disease. Two percent of the patients (n = 69) had maximum ST-segment depression in leads V 1 through V 3 and were selected for this study. Initial ECG changes were compared to final myocardial infarction size, using the Selvester QRS score as the end point. RESULTS: The quantity of initial ST-segment deviation correlated with the final AMI size (r = 0.43, P < .0005). The formula 3[0.22 (SigmaST downward arrow + SigmaST upward arrow) -0.02], where downward arrow indicates depression and upward arrow elevation, derived from measurements on the initial ECG, predicted the size of the AMI in percentage of the left ventricle as estimated on the final ECG. The study population had a large proportion of AMI (73%) indicated to be in or adjacent to the posterior left ventricular wall. CONCLUSION: The quantitative initial ST-segment deviation correlates linearly to the final AMI size in patients with maximum ST-segment depression in leads V 1 through V 3. The formula derived could be valuable for selecting patients who fail to meet strict ST-elevation AMI criteria for emergency intravenous or intracoronary reperfusion therapy.
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| 6. |
- Stensjøen, Anne Line, et al.
(author)
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Worst lead ST deviation and resolution of ST elevation at one hour for prediction of myocardial salvage, infarct size, and microvascular obstruction in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention
- 2020
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In: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X .- 1542-474X. ; 25:6
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Journal article (peer-reviewed)abstract
- Background: ECG changes after revascularization predicts improved outcome for patients with ST-elevation myocardial infarction (STEMI). Worst lead residual (WLR) ST deviation and resolution of worst lead ST elevation (rST elevation) are simple measures that can be obtained early after PCI. The objective of the current study was to investigate whether simple ECG measures, obtained one hour following PCI, could predict cardiac magnetic resonance (CMR)-derived myocardial salvage index (MSI), infarct size (IS), and microvascular obstruction (MVO) in patients with STEMI included in the MITOCARE trial. Methods: The MITOCARE trial included 165 patients with a first-time STEMI presenting within six hours of symptom onset. The current analysis included patients that had an ECG recorded at baseline and one hour after PCI and underwent CMR imaging after 3–5 days. Independent core laboratories determined WLR ST deviation, rST elevation, and the CMR variables (MSI, IS, and MVO). Results: 83 patients with a mean age of 61 years were included. 83.1% were males and 41% had anterior infarctions. In logistic regression models, WLR ST deviation was a statistically significant predictor of IS (OR 2.2, 95% CI 1.3–3.8) and MVO (OR 2.8, 95% CI 1.5–5.2), but not of MSI (OR 0.8, 95% CI 0.5–1.2). rST elevation showed a trend toward a significant association with IS (OR 0.3, 95% CI 0.1–1.0), but not with the other CMR variables. Conclusion: WLR ST deviation one hour after PCI was a predictor of IS and MVO. WLR ST deviation, a measure easily obtained from ECGs following PCI, may provide important prognostic information in patients with STEMI.
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