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The significance of ST-elevation in aVL in anterolateral myocardial infarction : An assessment by cardiac 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 Annals of Noninvasive Electrocardiology
Abstract

Background: Anterolateral myocardial infarction (MI) is traditionally defined on the electrocardiogram by ST-elevation (STE) in I, aVL, and the precordial leads. Traditional literature holds STE in lead aVL to be associated with occlusion proximal to the first diagonal branch of the left anterior descending coronary artery. However, concomitant ischemia of the inferior myocardium may theoretically lead to attenuation of STE in aVL. We compared segmental distribution of myocardial area at risk (MaR) in patients with and without STE in aVL. Methods: We identified patients in the MITOCARE study presenting with a first acute MI and new STE in two contiguous anterior leads from V1 to V6, with or without aVL STE.... (More)

Background: Anterolateral myocardial infarction (MI) is traditionally defined on the electrocardiogram by ST-elevation (STE) in I, aVL, and the precordial leads. Traditional literature holds STE in lead aVL to be associated with occlusion proximal to the first diagonal branch of the left anterior descending coronary artery. However, concomitant ischemia of the inferior myocardium may theoretically lead to attenuation of STE in aVL. We compared segmental distribution of myocardial area at risk (MaR) in patients with and without STE in aVL. Methods: We identified patients in the MITOCARE study presenting with a first acute MI and new STE in two contiguous anterior leads from V1 to V6, with or without aVL STE. Patients underwent cardiac magnetic resonance imaging 3-5 days after acute infarction for quantitative assessment of MaR. Results: A total of 32 patients met inclusion criteria; 13 patients with and 19 without STE in lead aVL. MaR > 20% at the basal anterior segment was seen in 54% of patients with aVL STE, and 11% of those without (p = 0.011). MaR > 20% at the apical inferior segment was seen in 62% and 95% of patients with and without aVL STE, respectively (p = 0.029). The total MaR was not different between groups (44% ± 10% and 39% ± 8.3% respectively, p = 0.15). Conclusion: Patients with anterior STEMI and concomitant STE in aVL have less MaR in the apical inferior segment and more MaR in the basal anterior segment.

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Annals of Noninvasive Electrocardiology
publisher
Wiley-Blackwell
external identifiers
  • scopus:85050860599
ISSN
1082-720X
DOI
10.1111/anec.12580
language
English
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no
id
e9493b29-81dc-4b36-806c-4f785761357a
date added to LUP
2018-08-30 08:56:14
date last changed
2019-02-20 11:25:12
@article{e9493b29-81dc-4b36-806c-4f785761357a,
  abstract     = {<p>Background: Anterolateral myocardial infarction (MI) is traditionally defined on the electrocardiogram by ST-elevation (STE) in I, aVL, and the precordial leads. Traditional literature holds STE in lead aVL to be associated with occlusion proximal to the first diagonal branch of the left anterior descending coronary artery. However, concomitant ischemia of the inferior myocardium may theoretically lead to attenuation of STE in aVL. We compared segmental distribution of myocardial area at risk (MaR) in patients with and without STE in aVL. Methods: We identified patients in the MITOCARE study presenting with a first acute MI and new STE in two contiguous anterior leads from V<sub>1</sub> to V<sub>6</sub>, with or without aVL STE. Patients underwent cardiac magnetic resonance imaging 3-5 days after acute infarction for quantitative assessment of MaR. Results: A total of 32 patients met inclusion criteria; 13 patients with and 19 without STE in lead aVL. MaR &gt; 20% at the basal anterior segment was seen in 54% of patients with aVL STE, and 11% of those without (p = 0.011). MaR &gt; 20% at the apical inferior segment was seen in 62% and 95% of patients with and without aVL STE, respectively (p = 0.029). The total MaR was not different between groups (44% ± 10% and 39% ± 8.3% respectively, p = 0.15). Conclusion: Patients with anterior STEMI and concomitant STE in aVL have less MaR in the apical inferior segment and more MaR in the basal anterior segment.</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         = {1082-720X},
  language     = {eng},
  month        = {01},
  publisher    = {Wiley-Blackwell},
  series       = {Annals of Noninvasive Electrocardiology},
  title        = {The significance of ST-elevation in aVL in anterolateral myocardial infarction : An assessment by cardiac magnetic resonance imaging},
  url          = {http://dx.doi.org/10.1111/anec.12580},
  year         = {2018},
}