TY - JOUR
T1 - The predischarge electrocardiographic pattern in anterior acute myocardial infarction
T2 - Relation between evolutionary ST segment and T-wave configuration and prediction of myocardial infarct size and left ventricular systolic function by the QRS Selvester score
AU - Birnbaum, Yochai
AU - Strasberg, Boris
PY - 2000
Y1 - 2000
N2 - Left ventricular systolic function, determined mainly by final infarct size, has a major influence on prognosis after acute myocardial infarction (MI). It was found that infarct size and left ventricular ejection fraction can be predicted using the Selvester QRS-score in patients not receiving reperfusion therapy. We assessed whether the predischarge QRS-score can be used for estimating infarct size and left ventricular ejection fraction in 51 patients with a first anterior MI who had received reperfusion therapy and whether considering the configuration of the ST-segments and T-waves will increase the accuracy of these predictions. All patients had received reperfusion therapy and had predischarge resting 99mTc-sestamibi scan. We determined the Selvester QRS score using the electrocardiograms performed on the same day of the scan. In addition, we divided the patients into 3 groups: A: isoelectric ST and negative T-waves (n = 12); B: ST elevation (≥0.1 mV) and negative T-waves (n = 23); and C: ST elevation (≥0.1 mV) and positive T-waves (n = 16). The myocardial perfusion defect extent increased from group A to C (28.5 ± 16.4%, 39.4 ± 14.8%, and 45.3 ± 15.8% in groups A, B, and C, respectively; P = .022). Similarly, the left ventricular ejection fraction decreased (41.7 ± 11.6%, 38.4 ± 8.1%, and 32.0 ± 9.7%, respectively; P = .042) from group A to C. Overall, the correlation between the QRS-score and the myocardial perfusion defect extent (Rho = 0.249; P = .08), and ejection fraction (Rho = -0.229; P = .11) was not good. A statistically significant correlation between the myocardial perfusion defect size and the QRS-score was found only in group A (Rho = 0.599, P = .04). In patients with a first anterior myocardial infarction who underwent reperfusion therapy, the predischarge QRS-score is predictive of infarct size only in those in whom ST elevation resolved completely. In patients with residual ST elevation the Selvester QRS-score is inaccurate in predicting infarct size and left ventricular ejection fraction upon discharge.
AB - Left ventricular systolic function, determined mainly by final infarct size, has a major influence on prognosis after acute myocardial infarction (MI). It was found that infarct size and left ventricular ejection fraction can be predicted using the Selvester QRS-score in patients not receiving reperfusion therapy. We assessed whether the predischarge QRS-score can be used for estimating infarct size and left ventricular ejection fraction in 51 patients with a first anterior MI who had received reperfusion therapy and whether considering the configuration of the ST-segments and T-waves will increase the accuracy of these predictions. All patients had received reperfusion therapy and had predischarge resting 99mTc-sestamibi scan. We determined the Selvester QRS score using the electrocardiograms performed on the same day of the scan. In addition, we divided the patients into 3 groups: A: isoelectric ST and negative T-waves (n = 12); B: ST elevation (≥0.1 mV) and negative T-waves (n = 23); and C: ST elevation (≥0.1 mV) and positive T-waves (n = 16). The myocardial perfusion defect extent increased from group A to C (28.5 ± 16.4%, 39.4 ± 14.8%, and 45.3 ± 15.8% in groups A, B, and C, respectively; P = .022). Similarly, the left ventricular ejection fraction decreased (41.7 ± 11.6%, 38.4 ± 8.1%, and 32.0 ± 9.7%, respectively; P = .042) from group A to C. Overall, the correlation between the QRS-score and the myocardial perfusion defect extent (Rho = 0.249; P = .08), and ejection fraction (Rho = -0.229; P = .11) was not good. A statistically significant correlation between the myocardial perfusion defect size and the QRS-score was found only in group A (Rho = 0.599, P = .04). In patients with a first anterior myocardial infarction who underwent reperfusion therapy, the predischarge QRS-score is predictive of infarct size only in those in whom ST elevation resolved completely. In patients with residual ST elevation the Selvester QRS-score is inaccurate in predicting infarct size and left ventricular ejection fraction upon discharge.
KW - Anterior acute myocardial infarction
KW - Electrocardiogram
KW - Infarct size
KW - Left ventricular ejection fraction
KW - Selvester QRS-score
KW - Tc-sestamibi scan
UR - http://www.scopus.com/inward/record.url?scp=0034472955&partnerID=8YFLogxK
U2 - 10.1054/jelc.200.20345
DO - 10.1054/jelc.200.20345
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AN - SCOPUS:0034472955
SN - 0022-0736
VL - 33
SP - 73
EP - 80
JO - Journal of Electrocardiology
JF - Journal of Electrocardiology
ER -