Electrocardiographic predictors of clinical outcome in ST-elevation myocardial infarction
(2015) In Lund University Faculty of Medicine Doctoral Dissertation Series 2015:88.- Abstract
- Malignant ventricular arrhythmias, particularly ventricular fibrillation (VF), remain an important contributor to mortality in
ST-elevation myocardial infarction (STEMI). The size of myocardial injury is one more important factor influencing the
prognosis of STEMI patients. The search for new non-invasive markers, which can be relatively simply calculated using
conventional ECG recording and can predict the degree of myocardial injury and impending VF, is promising. This work is
aimed at investigating cardiac repolarization and depolarization abnormalities and predictors and prognosis of ventricular
arrhythmias during the course of STEMI.
The thesis is composed of the experimental part... (More) - Malignant ventricular arrhythmias, particularly ventricular fibrillation (VF), remain an important contributor to mortality in
ST-elevation myocardial infarction (STEMI). The size of myocardial injury is one more important factor influencing the
prognosis of STEMI patients. The search for new non-invasive markers, which can be relatively simply calculated using
conventional ECG recording and can predict the degree of myocardial injury and impending VF, is promising. This work is
aimed at investigating cardiac repolarization and depolarization abnormalities and predictors and prognosis of ventricular
arrhythmias during the course of STEMI.
The thesis is composed of the experimental part (Studies I, II, III) and clinical register-based retrospective studies (Studies IV
and V). Closed-chest porcine model of myocardial infarction (MI) was used in the experimental part. Occlusion of left
descending artery (LAD) lasted 40 minutes and was followed by reperfusion, and ECG was continuously recorded. QRSduration
and morphology, dynamics of ST-segment and T-wave alternans (TWA) were calculated, and myocardial area at
risk (MaR) and infarct size (IS) were assessed. Predictors and prognostic impact of early VF in STEMI was assessed in a
register-based study of 1,718 consecutive patients admitted for primary PCI during 2007-2009 who were followed up for
one year.
In experimental MI, the maximal level of TWA during occlusion period was associated with both MaR and IS (Study II).
Rapid and marked transient increase in QRS duration associated with appearance of J-wave pattern predicted impending VF
in acute ischemia (Study III). Restoration of blood flow in infarct-related artery was accompanied by reperfusion peak in all
animals, and the magnitude of ST elevation at reperfusion peak was associated with infarct size (Study I). In clinical studies
IV and V, the risk of VF in acute period of STEMI was higher in patients with MI history, cardiovascular risk factors such as
smoking and left main stenosis, resulting in a large infarct area. Besides MI history and left main stenosis, the risk of VF at
reperfusion was associated with inferior localization of STEMI, hypokalemia, high ST-elevation and shorter symptom-toballoon
time. The magnitude of ST-elevation before PCI for STEMI independently predicted reperfusion VF. Patients
successfully resuscitated after VF and alive at 48 hours had higher in-hospital mortality (12% vs. 2%, p<0.001). However, in
VF patients who were discharged alive, 1-year mortality did not differ compared with patients without VF (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/8034420
- author
- Demidova, Marina LU
- supervisor
-
- Pyotr Platonov LU
- David Erlinge LU
- opponent
-
- Lombardi, Federico, University of Milan
- organization
- publishing date
- 2015
- type
- Thesis
- publication status
- published
- subject
- in
- Lund University Faculty of Medicine Doctoral Dissertation Series
- volume
- 2015:88
- pages
- 79 pages
- publisher
- Cardiology, Clinical Science, Lund, Lund University
- defense location
- Segerfalksalen, Wallenberg Neurocentrum, BMC A10, Sölvegatan 17, Lund
- defense date
- 2015-09-18 09:00:00
- ISSN
- 1652-8220
- ISBN
- 978-91-7619-167-5
- language
- English
- LU publication?
- yes
- id
- 6639817c-b0b9-41d7-b65a-1138d311ccf4 (old id 8034420)
- date added to LUP
- 2016-04-01 13:09:25
- date last changed
- 2019-05-21 21:41:44
@phdthesis{6639817c-b0b9-41d7-b65a-1138d311ccf4, abstract = {{Malignant ventricular arrhythmias, particularly ventricular fibrillation (VF), remain an important contributor to mortality in<br/><br> ST-elevation myocardial infarction (STEMI). The size of myocardial injury is one more important factor influencing the<br/><br> prognosis of STEMI patients. The search for new non-invasive markers, which can be relatively simply calculated using<br/><br> conventional ECG recording and can predict the degree of myocardial injury and impending VF, is promising. This work is<br/><br> aimed at investigating cardiac repolarization and depolarization abnormalities and predictors and prognosis of ventricular<br/><br> arrhythmias during the course of STEMI.<br/><br> The thesis is composed of the experimental part (Studies I, II, III) and clinical register-based retrospective studies (Studies IV<br/><br> and V). Closed-chest porcine model of myocardial infarction (MI) was used in the experimental part. Occlusion of left<br/><br> descending artery (LAD) lasted 40 minutes and was followed by reperfusion, and ECG was continuously recorded. QRSduration<br/><br> and morphology, dynamics of ST-segment and T-wave alternans (TWA) were calculated, and myocardial area at<br/><br> risk (MaR) and infarct size (IS) were assessed. Predictors and prognostic impact of early VF in STEMI was assessed in a<br/><br> register-based study of 1,718 consecutive patients admitted for primary PCI during 2007-2009 who were followed up for<br/><br> one year.<br/><br> In experimental MI, the maximal level of TWA during occlusion period was associated with both MaR and IS (Study II).<br/><br> Rapid and marked transient increase in QRS duration associated with appearance of J-wave pattern predicted impending VF<br/><br> in acute ischemia (Study III). Restoration of blood flow in infarct-related artery was accompanied by reperfusion peak in all<br/><br> animals, and the magnitude of ST elevation at reperfusion peak was associated with infarct size (Study I). In clinical studies<br/><br> IV and V, the risk of VF in acute period of STEMI was higher in patients with MI history, cardiovascular risk factors such as<br/><br> smoking and left main stenosis, resulting in a large infarct area. Besides MI history and left main stenosis, the risk of VF at<br/><br> reperfusion was associated with inferior localization of STEMI, hypokalemia, high ST-elevation and shorter symptom-toballoon<br/><br> time. The magnitude of ST-elevation before PCI for STEMI independently predicted reperfusion VF. Patients<br/><br> successfully resuscitated after VF and alive at 48 hours had higher in-hospital mortality (12% vs. 2%, p<0.001). However, in<br/><br> VF patients who were discharged alive, 1-year mortality did not differ compared with patients without VF}}, author = {{Demidova, Marina}}, isbn = {{978-91-7619-167-5}}, issn = {{1652-8220}}, language = {{eng}}, publisher = {{Cardiology, Clinical Science, Lund, Lund University}}, school = {{Lund University}}, series = {{Lund University Faculty of Medicine Doctoral Dissertation Series}}, title = {{Electrocardiographic predictors of clinical outcome in ST-elevation myocardial infarction}}, url = {{https://lup.lub.lu.se/search/files/3195505/8034421.pdf}}, volume = {{2015:88}}, year = {{2015}}, }