Predicting Recovery of Myocardial Function by Electrocardiography after Acute Infarction

• Published in: Annals of noninvasive electrocardiology Vol. 18; no. 3; pp. 230 - 239
• Main Authors: Kylmälä, Minna M., Konttila, Teijo, Vesterinen, Paula, Lindholm, Mats, Väänänen, Heikki, Stenroos, Matti, Nieminen, Markku S., Hänninen, Helena, Toivonen, Lauri
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-05-2013; John Wiley & Sons, Inc; John Wiley and Sons Inc
• Subjects: Body Surface Potential Mapping; Coronary Angiography; Coronary Artery Bypass; Echocardiography; electrocardiography; Female; Humans; Male; Middle Aged; myocardial contraction; myocardial infarction; Myocardial Infarction - diagnosis; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Original; Percutaneous Coronary Intervention; Predictive Value of Tests; Recovery of Function; Thrombolytic Therapy; viability
• ISSN: 1082-720X; 1542-474X
• DOI: 10.1111/anec.12015

Background
In acute ischemic left ventricular (LV) dysfunction, distinguishing viable myocardium is clinically important.
Methods
Body surface potential mapping (Electrocardiography [ECG] with 123 leads), was recorded in 62 patients with acute coronary syndrome (ACS). ECG variables were computed from de‐ and repolarization phases. LV segmental wall motion was assessed by echocardiography acutely and after 1 year.
Results
The number of dysfunctional segments (DFS) diminished during follow‐up in 37 patients (recovery group) and remained the same or increased in 25 patients (nonrecovery group). Acutely, DFS was 5.7 ± 2.1 versus 4.4 ± 2.4 (P = 0.02), and peak CK‐MBm 141 ± 157 versus 156 ± 167 μg/L (P = 0.78) in the recovery versus nonrecovery group. At follow‐up, DFS was 1.9 ± 1.7 versus 6.5 ± 2.6 (P < 0.001). The best ECG variable to predict decrease in DFS depended on the region of acute LV dysfunction: The best variable in the left anterior descending region was the integral of the first QRS integral (area under the curve [AUC] 0.82, P = 0.002); in the right coronary artery region, this was the integral of the ST segment (AUC 0.98, P = 0.003); and in the left circumflex region, the area including the ST segment and the T wave (AUC 0.97, P = 0.006).
Conclusions
In ACS patients, computed ECG variables predict recovery of LV function from ischemic myocardial injury, even in the presence of comparable CK‐MBm release and LV dysfunction.