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Electrocardiographic scores of severity and acuteness of myocardial ischemia predict myocardial salvage in patients with anterior ST-segment elevation myocardial infarction

Fakhri, Yama; Sejersten, Maria; Schoos, Mikkel Malby; Hansen, Henrik Steen; Dubois-Rande, Jean Luc; Hall, Trygve S.; Larsen, Alf Inge; Jensen, Svend Eggert; Engblom, Henrik LU and Arheden, Hakon, et al. (2017) In Journal of Electrocardiology
Abstract

Background: Terminal "QRS distortion" on the electrocardiogram (ECG) (based on Sclarovsky-Birnbaum's Grades of Ischemia Score) is a sign of severe ischemia, associated with adverse cardiovascular outcome in ST-segment elevation myocardial infarction (STEMI). In addition, ECG indices of the acuteness of ischemia (based on Anderson-Wilkins Acuteness Score) indicate myocardial salvage potential. We assessed whether severe ischemia with or without acute ischemia is predictive of infarct size (IS), myocardial salvage index (MSI) and left ventricular ejection fraction (LVEF) in anterior versus inferior infarct locations. Methods: In STEMI patients, the severity and acuteness scores were obtained from the admission ECG. Based on the ECG... (More)

Background: Terminal "QRS distortion" on the electrocardiogram (ECG) (based on Sclarovsky-Birnbaum's Grades of Ischemia Score) is a sign of severe ischemia, associated with adverse cardiovascular outcome in ST-segment elevation myocardial infarction (STEMI). In addition, ECG indices of the acuteness of ischemia (based on Anderson-Wilkins Acuteness Score) indicate myocardial salvage potential. We assessed whether severe ischemia with or without acute ischemia is predictive of infarct size (IS), myocardial salvage index (MSI) and left ventricular ejection fraction (LVEF) in anterior versus inferior infarct locations. Methods: In STEMI patients, the severity and acuteness scores were obtained from the admission ECG. Based on the ECG patients were assigned with severe or non-severe ischemia and acute or non-acute ischemia. Cardiac magnetic resonance (CMR) was performed 2-6. days after primary percutaneous coronary intervention (pPCI). LVEF was measured by echocardiography 30. days after pPCI. Results: ECG analysis of 85 patients with available CMR resulted in 20 (23%) cases with severe and non-acute ischemia, 43 (51%) with non-severe and non-acute ischemia, 17 (20%) with non-severe and acute ischemia, and 5 (6%) patients with severe and acute ischemia. In patients with anterior STEMI (n = 35), ECG measures of severity and acuteness of ischemia identified significant and stepwise differences in myocardial damage and function. Patients with severe and non-acute ischemia had the largest IS, smallest MSI and lowest LVEF. In contrast, no difference was observed in patients with inferior STEMI (n = 50). Conclusions: The applicability of ECG indices of severity and acuteness of myocardial ischemia to estimate myocardial damage and salvage potential in STEMI patients treated with pPCI, is confined to anterior myocardial infarction.

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Acuteness of myocardial ischemia, ECG, Severity of myocardial ischemia, STEMI
in
Journal of Electrocardiology
publisher
Elsevier
external identifiers
  • scopus:85034993757
ISSN
0022-0736
DOI
10.1016/j.jelectrocard.2017.11.002
language
English
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yes
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89092bf1-00c2-424e-a9ed-058cc09dd2e5
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2017-12-28 10:46:06
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2018-01-12 14:58:45
@article{89092bf1-00c2-424e-a9ed-058cc09dd2e5,
  abstract     = {<p>Background: Terminal "QRS distortion" on the electrocardiogram (ECG) (based on Sclarovsky-Birnbaum's Grades of Ischemia Score) is a sign of severe ischemia, associated with adverse cardiovascular outcome in ST-segment elevation myocardial infarction (STEMI). In addition, ECG indices of the acuteness of ischemia (based on Anderson-Wilkins Acuteness Score) indicate myocardial salvage potential. We assessed whether severe ischemia with or without acute ischemia is predictive of infarct size (IS), myocardial salvage index (MSI) and left ventricular ejection fraction (LVEF) in anterior versus inferior infarct locations. Methods: In STEMI patients, the severity and acuteness scores were obtained from the admission ECG. Based on the ECG patients were assigned with severe or non-severe ischemia and acute or non-acute ischemia. Cardiac magnetic resonance (CMR) was performed 2-6. days after primary percutaneous coronary intervention (pPCI). LVEF was measured by echocardiography 30. days after pPCI. Results: ECG analysis of 85 patients with available CMR resulted in 20 (23%) cases with severe and non-acute ischemia, 43 (51%) with non-severe and non-acute ischemia, 17 (20%) with non-severe and acute ischemia, and 5 (6%) patients with severe and acute ischemia. In patients with anterior STEMI (n = 35), ECG measures of severity and acuteness of ischemia identified significant and stepwise differences in myocardial damage and function. Patients with severe and non-acute ischemia had the largest IS, smallest MSI and lowest LVEF. In contrast, no difference was observed in patients with inferior STEMI (n = 50). Conclusions: The applicability of ECG indices of severity and acuteness of myocardial ischemia to estimate myocardial damage and salvage potential in STEMI patients treated with pPCI, is confined to anterior myocardial infarction.</p>},
  author       = {Fakhri, Yama and Sejersten, Maria and Schoos, Mikkel Malby and Hansen, Henrik Steen and Dubois-Rande, Jean Luc and Hall, Trygve S. and Larsen, Alf Inge and Jensen, Svend Eggert and Engblom, Henrik and Arheden, Hakon and Kastrup, Jens and Atar, Dan and Clemmensen, Peter},
  issn         = {0022-0736},
  keyword      = {Acuteness of myocardial ischemia,ECG,Severity of myocardial ischemia,STEMI},
  language     = {eng},
  month        = {11},
  publisher    = {Elsevier},
  series       = {Journal of Electrocardiology},
  title        = {Electrocardiographic scores of severity and acuteness of myocardial ischemia predict myocardial salvage in patients with anterior ST-segment elevation myocardial infarction},
  url          = {http://dx.doi.org/10.1016/j.jelectrocard.2017.11.002},
  year         = {2017},
}