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[The ECG in prediction of the infarcted artery and left ventricular dysfunction]
1III. interní-kardiologická klinika 3. lékarské fakulty UK a FN Královské Vinohrady, Praha.
Insights
Electrocardiogram (ECG) changes can predict the infarcted artery in acute myocardial infarction (AMI) patients. More than four pathological Q waves on ECG indicate severe left ventricular dysfunction.
Area of Science:
- Cardiology
- Medical Imaging
Context:
- Acute myocardial infarction (AMI) diagnosis and management.
- The role of electrocardiography (ECG) in identifying infarct-related arteries.
- Assessing left ventricular function post-AMI.
Purpose:
- To evaluate the predictive capability of ECG for identifying the infarcted artery in AMI patients.
- To determine the relationship between left ventricular function and the number of pathological Q waves on ECG.
Summary:
- A study of 216 AMI patients treated with primary percutaneous transluminal coronary angioplasty (PTCA) analyzed ECG findings against coronarography and cardiac enzyme levels.
- ST-segment elevation in leads V1-V4 strongly predicts Left Anterior Descending (LAD) artery occlusion (96% sensitivity).
- The presence of more than four pathological Q waves on discharge ECG correlated with significantly reduced left ventricular ejection fraction (32% vs. 49%).
Impact:
- ECG findings can guide the identification of the occluded artery in AMI.
- ECG-derived pathological Q waves serve as a non-invasive marker for predicting severe left ventricular dysfunction after AMI.
Objective:
To assess the possibilities of ECG in prediction of an infarcted artery in patients with acute myocardial infarction (AIM) and evaluate the relationship of left ventricular function to the number of pathological Qs.
Method:
The trial comprises 216 patients with acute myocardial infarction (AMI) treated by primary PTCA. The diagnosis of AIM was confirmed in addition to ECG also by coronarography and elevation of cardiospecific enzymes. On the baseline 12-lead ECG denivelization of the ST segment > 1 mm was considered significant. The number of pathological Q waves on the ECG tracing on discharge was compared with left ventricular function according to the ejection fraction assessed echocardiographically before discharge.
Results:
Elevation of ST in leads V1-V4 predicts occlusion of LAD with a sensitivity of 96% and specificity of 69% (p < 0.001 vs. RC segment with a sensitivity of 80% and specificity of 48% (p < 0.001). In inferior AMI the ST elevation in III > II develops in 70% in occlusion of RCA vs. 27% in occlusion of LCX. The mean left ventricular ejection fraction before discharge was in patients with four or fewer pathological Q waves 49 +/- 10% vs. 32 +/- 9% in the presence of pathological Q waves in > 4 leads.
Conclusion:
In patients with AMI according to ECG changes in different leads conclusions may be drawn on the infarcted artery. The presence of pathological Q waves in more than 4 leads predicts severe left ventricular dysfunction.