Ischemic QRS prolongation as a biomarker of myocardial injury in STEMI patients
Almer, Jakob LU ; Elmberg, Viktor LU
; Bränsvik, Josef
; Nordlund, David
LU
; Khoshnood, Ardavan
LU
; Ringborn, Michael
; Carlsson, Marcus
LU
; Ekelund, Ulf
LU
and Engblom, Henrik
LU
(2019)
In Annals of Noninvasive Electrocardiology
24(1).
- Abstract
BACKGROUND: Patients with acute coronary occlusion (ACO) may not only have ischemia-related ST-segment changes but also changes in the QRS complex. It has recently been shown in dogs that a greater ischemic QRS prolongation (IQP) during ACO is related to lower collateral flow. This suggests that greater IQP could indicate more severe ischemia and thereby more rapid infarct development. Therefore, the purpose was to evaluate the relationship between IQP and measures of myocardial injury in patients presenting with acute ST-elevation myocardial infarction (STEMI).
METHODS: Seventy-seven patients with first-time STEMI were retrospectively included from the recently published SOCCER trial. All patients underwent a cardiac magnetic... (More)
BACKGROUND: Patients with acute coronary occlusion (ACO) may not only have ischemia-related ST-segment changes but also changes in the QRS complex. It has recently been shown in dogs that a greater ischemic QRS prolongation (IQP) during ACO is related to lower collateral flow. This suggests that greater IQP could indicate more severe ischemia and thereby more rapid infarct development. Therefore, the purpose was to evaluate the relationship between IQP and measures of myocardial injury in patients presenting with acute ST-elevation myocardial infarction (STEMI).
METHODS: Seventy-seven patients with first-time STEMI were retrospectively included from the recently published SOCCER trial. All patients underwent a cardiac magnetic resonance (CMR) examination 2-6 days after the acute event. Infarct size (IS), myocardium at risk (MaR), and myocardial salvage index (MSI) were assessed and related to IQP. IQP measures assessed were; computer-generated QRS duration, QRS duration at maximum ST deviation, absolute IQP and relative IQP, all derived from a pre-PCI, 12-lead ECG.
RESULTS: Median absolute IQP was 10 ms (range 0-115 ms). There were no statistically significant correlations between measures of IQP and any of the CMR measures of myocardial injury (absolute IQP vs IS, r = 0.03, p = 0.80; MaR, r = -0.01, p = 0.89; MSI, r = -0.05, p = 0.68).
CONCLUSIONS: Unlike previous experimental studies, the IQP was limited in patients presenting at the emergency room with first-time STEMI and no correlation was found between IQP and CMR variables of myocardial injury in these patients. Therefore, IQP does not seem to be a suitable biomarker for triaging patients in this clinical context.
(Less)
- author
- Almer, Jakob
LU
; Elmberg, Viktor
LU
; Bränsvik, Josef
; Nordlund, David
LU
; Khoshnood, Ardavan
LU
; Ringborn, Michael
; Carlsson, Marcus
LU
; Ekelund, Ulf
LU
and Engblom, Henrik
LU
- organization
- publishing date
- 2019
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- ECG, STEMI, Cardiology, Emergency Medicine, EKG, STEMI, Kardiologi, Akutsjukvård
- in
- Annals of Noninvasive Electrocardiology
- volume
- 24
- issue
- 1
- article number
- e12601
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:30265437
- scopus:85054050543
- ISSN
- 1082-720X
- DOI
- 10.1111/anec.12601
- language
- English
- LU publication?
- yes
- id
- 076d2460-c3ae-465a-8dfa-74d451c68725
- date added to LUP
- 2018-10-08 16:20:57
- date last changed
- 2024-06-10 19:06:29
@article{076d2460-c3ae-465a-8dfa-74d451c68725,
abstract = {{<p>BACKGROUND: Patients with acute coronary occlusion (ACO) may not only have ischemia-related ST-segment changes but also changes in the QRS complex. It has recently been shown in dogs that a greater ischemic QRS prolongation (IQP) during ACO is related to lower collateral flow. This suggests that greater IQP could indicate more severe ischemia and thereby more rapid infarct development. Therefore, the purpose was to evaluate the relationship between IQP and measures of myocardial injury in patients presenting with acute ST-elevation myocardial infarction (STEMI).</p><p>METHODS: Seventy-seven patients with first-time STEMI were retrospectively included from the recently published SOCCER trial. All patients underwent a cardiac magnetic resonance (CMR) examination 2-6 days after the acute event. Infarct size (IS), myocardium at risk (MaR), and myocardial salvage index (MSI) were assessed and related to IQP. IQP measures assessed were; computer-generated QRS duration, QRS duration at maximum ST deviation, absolute IQP and relative IQP, all derived from a pre-PCI, 12-lead ECG.</p><p>RESULTS: Median absolute IQP was 10 ms (range 0-115 ms). There were no statistically significant correlations between measures of IQP and any of the CMR measures of myocardial injury (absolute IQP vs IS, r = 0.03, p = 0.80; MaR, r = -0.01, p = 0.89; MSI, r = -0.05, p = 0.68).</p><p>CONCLUSIONS: Unlike previous experimental studies, the IQP was limited in patients presenting at the emergency room with first-time STEMI and no correlation was found between IQP and CMR variables of myocardial injury in these patients. Therefore, IQP does not seem to be a suitable biomarker for triaging patients in this clinical context.</p>}},
author = {{Almer, Jakob and Elmberg, Viktor and Bränsvik, Josef and Nordlund, David and Khoshnood, Ardavan and Ringborn, Michael and Carlsson, Marcus and Ekelund, Ulf and Engblom, Henrik}},
issn = {{1082-720X}},
keywords = {{ECG; STEMI; Cardiology; Emergency Medicine; EKG; STEMI; Kardiologi; Akutsjukvård}},
language = {{eng}},
number = {{1}},
publisher = {{Wiley-Blackwell}},
series = {{Annals of Noninvasive Electrocardiology}},
title = {{Ischemic QRS prolongation as a biomarker of myocardial injury in STEMI patients}},
url = {{http://dx.doi.org/10.1111/anec.12601}},
doi = {{10.1111/anec.12601}},
volume = {{24}},
year = {{2019}},
}