Related Experiment Videos
ST-segment depression in lead aVR predicts predischarge left ventricular dysfunction in patients with reperfused
M Kosuge1, K Kimura, T Ishikawa
1Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
Insights
ST-segment depression in lead aVR on an electrocardiogram (ECG) can predict left ventricular dysfunction in patients with anterolateral acute myocardial infarction (AMI). This finding is crucial for identifying high-risk patients needing closer monitoring and management.
Area of Science:
- Cardiology
- Electrocardiography
- Myocardial Infarction
Background:
- Anterolateral acute myocardial infarction (AMI) is associated with a worse prognosis.
- Inferolateral wall involvement in AMI may indicate a larger area at risk and higher patient risk.
- Lead aVR, derived from inverted lead aVR imaging, offers insights into inferolateral lesions.
Purpose of the Study:
- To investigate the relationship between ST-segment deviation in lead aVR on admission electrocardiogram (ECG) and left ventricular function in patients with anterolateral AMI.
- To assess the predictive value of lead aVR ST-segment changes for infarct size and left ventricular dysfunction post-reperfusion therapy.
Main Methods:
- 105 patients with anterolateral AMI and successful reperfusion within 6 hours were analyzed.
- Patients were categorized based on ST-segment deviation in lead aVR: ST elevation (Group A), no deviation (Group B), and ST depression (Group C).
- Left ventricular ejection fraction (LVEF) was assessed by predischarge left ventriculography.
Main Results:
- Group C (ST depression) showed significantly higher peak creatine kinase levels and lower LVEF (37% ± 9%) compared to Groups A and B.
- Congestive heart failure occurred more frequently in Group C.
- ST-segment depression in lead aVR demonstrated higher accuracy in predicting LVEF < or = 35% than other ECG findings.
Conclusions:
- ST-segment depression in lead aVR on admission ECG is a valuable predictor of larger infarct size and left ventricular dysfunction in anterolateral AMI patients.
- This ECG finding is useful even after successful reperfusion therapy.
- Lead aVR analysis aids in identifying high-risk patients with anterolateral AMI requiring closer monitoring.
Background:
Patients with an anterolateral acute myocardial infarction (AMI) have a worse prognosis, and those with additional inferolateral wall involvement might be higher risk because of more extensive area at risk. Lead -aVR obtained by inversion of images in lead aVR has been reported to provide useful information for inferolateral lesion.
Methods:
We examined the relation between ST-segment deviation in lead aVR on admission electrocardiogram (ECG) and left ventricular function in 105 patients with an anterolateral AMI undergoing successful reperfusion < or = 6 hours after onset. Patients were classified according to ST-segment deviation in lead aVR on admission ECG: group A, 23 patients with ST elevation of > or = 0.5 mm; group B, 47 patients without ST deviation; and group C, 35 patients with ST depression of > or = 0.5 mm.
Results:
There were no differences among the 3 groups in age, sex, or site of the culprit lesion. In groups A, B, and C, the peak creatine kinase level was 3661 +/- 1428, 4440 +/- 1889, and 6959 +/- 2712 mU/mL, and the left ventricular ejection fraction (LVEF) measured by predischarge left ventriculography was 54% +/- 9%, 48% +/- 7%, and 37% +/- 9%, respectively(P < .01). During hospitalization, congestive heart failure occurred more frequently in group C than in groups A or B (P < .05). ST-segment depression in lead aVR had a higher predictive accuracy than other ECG findings in identifying patients with predischarge LVEF < or = 35%.
Conclusions:
We conclude that in patients with an anterolateral AMI, ST-segment depression in lead aVR on admission ECG is useful for predicting larger infarct and left ventricular dysfunction despite successful reperfusion.