Predicting Recovery of Myocardial Function by Electrocardiography after Acute Infarction
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 fro...
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| Published in: | Annals of noninvasive electrocardiology Vol. 18; no. 3; pp. 230 - 239 |
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| Main Authors: | , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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United States
Blackwell Publishing Ltd
01-05-2013
John Wiley & Sons, Inc John Wiley and Sons Inc |
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| Abstract | 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. |
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| AbstractList | BACKGROUNDIn acute ischemic left ventricular (LV) dysfunction, distinguishing viable myocardium is clinically important. METHODSBody 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. RESULTSThe 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). CONCLUSIONSIn 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. 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. In acute ischemic left ventricular (LV) dysfunction, distinguishing viable myocardium is clinically important. 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. 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). 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. 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. [PUBLICATION ABSTRACT] |
| Author | Hänninen, Helena Stenroos, Matti Kylmälä, Minna M. Vesterinen, Paula Nieminen, Markku S. Lindholm, Mats Väänänen, Heikki Konttila, Teijo Toivonen, Lauri |
| AuthorAffiliation | 1 Division of Cardiology Helsinki University Central Hospital 2 BioMag Laboratory, Hospital District of Helsinki and Uusimaa HUSLAB Helsinki University Central Hospital Helsinki 3 Department of Biomedical Engineering and Computational Science Aalto University Espoo Finland |
| AuthorAffiliation_xml | – name: 3 Department of Biomedical Engineering and Computational Science Aalto University Espoo Finland – name: 1 Division of Cardiology Helsinki University Central Hospital – name: 2 BioMag Laboratory, Hospital District of Helsinki and Uusimaa HUSLAB Helsinki University Central Hospital Helsinki |
| Author_xml | – sequence: 1 givenname: Minna M. surname: Kylmälä fullname: Kylmälä, Minna M. email: Address for correspondence: Minna M. Kylmälä, M.D., Division of Cardiology, Helsinki University Central Hospital, P.O.B. 340, 00029 HUS, Finland. Fax: + 358 9 5042412; , minna.kylmala@hus.fi organization: Division of Cardiology, Helsinki University Central Hospital – sequence: 2 givenname: Teijo surname: Konttila fullname: Konttila, Teijo organization: Department of Biomedical Engineering and Computational Science, Aalto University, Finland, Espoo – sequence: 3 givenname: Paula surname: Vesterinen fullname: Vesterinen, Paula organization: Division of Cardiology, Helsinki University Central Hospital – sequence: 4 givenname: Mats surname: Lindholm fullname: Lindholm, Mats organization: Department of Biomedical Engineering and Computational Science, Aalto University, Finland, Espoo – sequence: 5 givenname: Heikki surname: Väänänen fullname: Väänänen, Heikki organization: Department of Biomedical Engineering and Computational Science, Aalto University, Finland, Espoo – sequence: 6 givenname: Matti surname: Stenroos fullname: Stenroos, Matti organization: Department of Biomedical Engineering and Computational Science, Aalto University, Finland, Espoo – sequence: 7 givenname: Markku S. surname: Nieminen fullname: Nieminen, Markku S. organization: Division of Cardiology, Helsinki University Central Hospital – sequence: 8 givenname: Helena surname: Hänninen fullname: Hänninen, Helena organization: Division of Cardiology, Helsinki University Central Hospital – sequence: 9 givenname: Lauri surname: Toivonen fullname: Toivonen, Lauri organization: Division of Cardiology, Helsinki University Central Hospital |
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| Cites_doi | 10.1016/S0002-8703(96)90266-5 10.1016/j.amjcard.2009.12.034 10.1111/j.1540-8159.1998.tb00013.x 10.1016/j.amjcard.2005.07.109 10.1161/01.CIR.68.1.170 10.1016/S0195-668X(02)00739-X 10.1111/j.1475-097X.2007.00723.x 10.1016/0021-9991(89)90103-4 10.1161/01.CIR.75.4.684 10.1016/j.ijcard.2006.12.029 10.1161/01.CIR.87.3.773 10.1001/archinte.1985.00360100147024 10.1007/s003990070021 10.1161/01.CIR.64.2.235 10.1016/j.jelectrocard.2009.06.003 10.1016/S0894-7317(89)80014-8 10.1161/hc0402.102975 10.1016/j.jacc.2003.07.052 10.1016/S0002-9149(02)02299-3 10.1159/000107784 10.1161/CIRCULATIONAHA.108.767772 |
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| Snippet | Background
In acute ischemic left ventricular (LV) dysfunction, distinguishing viable myocardium is clinically important.
Methods
Body surface potential... In acute ischemic left ventricular (LV) dysfunction, distinguishing viable myocardium is clinically important. Body surface potential mapping... Background In acute ischemic left ventricular (LV) dysfunction, distinguishing viable myocardium is clinically important. Methods Body surface potential... BACKGROUNDIn acute ischemic left ventricular (LV) dysfunction, distinguishing viable myocardium is clinically important. METHODSBody surface potential mapping... |
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| SubjectTerms | 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 |
| Title | Predicting Recovery of Myocardial Function by Electrocardiography after Acute Infarction |
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