The Relationship Between Terminal QRS Complex Distortion and Early Low Dose Dobutamine Stress Echocardiography in Acute Anterior Myocardial Infarction

スポンサーリンク

概要

• 論文の詳細を見る

• Although the damage in myocardial infarction has been demonstrated to be related with the magnitude and number of ST elevation, its relation with terminal distortion of QRS is unclear. The relationship between terminal QRS distortion in ECGs on admission and the results of early low dose dobutamine stress echocardiography (LDSE) performed 6 ± 2 days later was investigated. Patients admitted to our clinic within the first six hours of their chest pain and without a prior infarction diagnosis were divided into two groups based on the admission electrocardiogram as the absence (QRS-, n = 33) or presence (QRS+, n = 29) of distortion of the terminal portion of the QRS in ≥ 2 leads (QRS+; J point at > 50% of the R wave amplitude in lateral leads or presence of ST elevation without S wave in leads V1-V3). There were no significant differences between the groups with respect to thrombolytic therapy or reperfusion criteria. During LDSE, the infarct zone wall motion score index (WMSI) in the QRS- group was significantly decreased relative to baseline (from 2.93 ± 0.65 to 2.37 ± 0.84, P = 0.02), and it was significantly different compared with WMSI in the QRS+ group (P = 0.005). Improvement of akinetic regions to hypokinetic regions in the infarct zone (IZ) was found to be 33.5% (44/131) in the QRS- group and 17.8% (27/151 P = 0.004) in the QRS+ group. Furthermore, 55.1% (10/29) of the patients in the QRS+ group and only 18.1% (6/33) of those in the QRS- group did not respond to LDSE (P < 0.05). In multiple logistic regression analysis, while there was no relationship between good left ventricular functions (WMSI < 2) and terminal QRS distortion under basal conditions (P = 0.07), an independent relation was observed to exist between them after LDSE (P = 0.03, OR 4.48, 95% CI, 1.13-17.7). Moreover, plasma CK levels were higher in the QRS+ group (P = 0.03), whereas the ejection fraction was worse (P = 0.01). In both groups, there was no correlation between the Selvester score and left ventricle WMSI at baseline, but this correlation was significantly improved with LDSE (QRS-; r = 0.39 P = 0.02 and QRS+; r = 0.44 P = 0.01) The viability in the IZ is relatively less in those patients with terminal QRS distortion observed in their ECG on admission. This simple classification would be useful in predicting left ventricular function at the time of discharge.

• International Heart Journal刊行会の論文

著者

• Toprak Nizamettin

  Department Of Cardiology Faculty Of Medicine Dicle University

• Karadede Abdulaziz

  Department Of Cardiology Medical Faculty Dicle University

• Ozturk Onder

  Department of Cardiology, Faculty of Medicine, Dicle University

• Sucu Mehmet

  Department of Cardiology, Faculty of Medicine, Dicle University

• Aydinalp Ozlem

  Department of Cardiology, Faculty of Medicine, Dicle University

関連論文

• Elevated Plasma Levels of N-terminal pro-Brain Natriuretic Peptide in Children with Acute Poststreptococcal Glomerulonephritis
• Relation Between QT Dispersion and Ventricular Arrhythmias In Uncomplicated Isolated Mitral Valve Prolapse
• Influence of Angiotensin-Converting Enzyme I/D Gene Polymorphism on the Right Ventricular Myocardial Performance Index in Patients With a First Acute Anterior Myocardial Infarction
• Insulin Response to Oral Glucose Loading and Coronary Artery Disease in Nondiabetics
• The Relationship Between Terminal QRS Complex Distortion and Early Low Dose Dobutamine Stress Echocardiography in Acute Anterior Myocardial Infarction
• Predischarge ST Segment and T Wave Patterns in Predicting Left Ventricular Function and Myocardial Viability in Q Wave Anterior Myocardial Infarction Patients

スポンサーリンク