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Correlation of anteroseptal ST elevation with myocardial infarction territories through cardiovascular magnetic resonance imaging

Allencherril, Joseph ; Fakhri, Yama ; Engblom, Henrik LU ; Heiberg, Einar LU ; Carlsson, Marcus LU ; Dubois-Rande, Jean Luc ; Halvorsen, Sigrun ; Hall, Trygve S. ; Larsen, Alf Inge and Jensen, Svend Eggert , et al. (2018) In Journal of Electrocardiology 51(4). p.563-568
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... (More)

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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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiology, Electrocardiography, Magnetic resonance imaging, Myocardial infarction, ST elevations
in
Journal of Electrocardiology
volume
51
issue
4
pages
6 pages
publisher
Elsevier
external identifiers
  • scopus:85046749862
  • pmid:29996989
ISSN
0022-0736
DOI
10.1016/j.jelectrocard.2018.03.016
language
English
LU publication?
yes
id
a9aa83ee-8896-4ab7-8342-9312fc490bba
date added to LUP
2018-05-21 14:33:40
date last changed
2020-10-20 03:31:55
@article{a9aa83ee-8896-4ab7-8342-9312fc490bba,
  abstract     = {<p>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) &gt; 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 &gt; 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.</p>},
  author       = {Allencherril, Joseph and Fakhri, Yama and Engblom, Henrik and Heiberg, Einar and Carlsson, Marcus and Dubois-Rande, Jean Luc and Halvorsen, Sigrun and Hall, Trygve S. and Larsen, Alf Inge and Jensen, Svend Eggert and Arheden, Hakan and Atar, Dan and Clemmensen, Peter and Ripa, Maria Sejersten and Birnbaum, Yochai},
  issn         = {0022-0736},
  language     = {eng},
  month        = {07},
  number       = {4},
  pages        = {563--568},
  publisher    = {Elsevier},
  series       = {Journal of Electrocardiology},
  title        = {Correlation of anteroseptal ST elevation with myocardial infarction territories through cardiovascular magnetic resonance imaging},
  url          = {http://dx.doi.org/10.1016/j.jelectrocard.2018.03.016},
  doi          = {10.1016/j.jelectrocard.2018.03.016},
  volume       = {51},
  year         = {2018},
}