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Ventricular dilation after anterior ST-elevation myocardial infarction in the thrombolytic era
A G Zaman1, G Helft, S G Worthley
1University Hospital of Wales, Cardiff, United Kingdom. azfarzaman@hotmail.com
Insights
Ventricular dilation after anterior ST-elevation myocardial infarction (STEMI) was studied. Some patients without Q waves also experienced significant dilation, highlighting the need for monitoring in these cases.
Area of Science:
- Cardiology
- Cardiovascular Research
- Medical Imaging
Background:
- Ventricular dilation post-anterior Q-wave myocardial infarction is known.
- Limited data exists on ventricular volume changes after non-Q-wave myocardial infarction.
Purpose of the Study:
- To investigate end-diastolic volume changes 6 months after Q-wave and non-Q-wave anterior ST-elevation myocardial infarction (STEMI).
- To compare the natural history of ventricular volumes in patients with and without Q-wave development after STEMI.
Main Methods:
- 190 patients with anterior STEMI receiving thrombolytic therapy were studied.
- 2D echocardiograms and ECGs were performed at baseline and multiple follow-up points (up to 180 days).
- End-diastolic volume index was assessed; Q-wave presence was determined on day 7 ECG.
Main Results:
- Peak creatine kinase levels correlated with ventricular dilation in both groups.
- Mean end-diastolic volume increased significantly in the Q-wave group but not the non-Q-wave group.
- 35% of Q-wave patients and 15% of non-Q-wave patients showed significant ventricular dilation (>10 mL/m²).
Conclusions:
- A subset of patients without Q-wave development after anterior STEMI experience significant ventricular dilation.
- This suggests that Q-wave presence alone may not fully predict adverse ventricular remodeling in STEMI.
Background:
The aim of this work was to study changes in end-diastolic volume 6 months after Q-wave and non-Q-wave anterior ST-elevation myocardial infarction by echocardiography. Ventricular dilation after anterior Q-wave myocardial infarction is well-recognized. However, there is a dearth of information about the natural history of ventricular volumes after non-Q-wave myocardial infarction.
Methods:
One hundred ninety patients receiving thrombolytic therapy after anterior ST-elevation myocardial infarction were studied. All patients had 2D echocardiograms and 12-lead electrocardiograms recorded within 24 hours of symptoms and at 3, 42, and 180 days later. In addition, a further electrocardiogram was recorded on day 7 to assess patients for the presence of Q waves. Peak creatine kinase over the first 3 days of admission was recorded. End-diastolic volume index was the study end point.
Results:
Peak creatine kinase was strongly associated with ventricular dilation in both groups (P <.001). Mean end-diastolic volume in the Q-wave group increased significantly from day 1 to 6 months (P <.05) but did not alter after non-Q-wave infarction. However, when patients were selected on predefined criteria for significant change in ventricular dilation (>10 mL/m(2)), then 35% of those with and 15% of those without Q waves fell into this category. Within this group, the increase in end-diastolic volume followed a similar pattern, with the maximum percentage increase occurring between day 1 and 6 weeks.
Conclusions:
In the postthrombolytic group of anterior ST-elevation myocardial infarction, a minority of patients without Q-wave development also undergo significant ventricular dilation.