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Correlation between ECG and myocardial perfusion after mechanical reperfusion of acute myocardial infarction
Petr Tousek1, Jiri Krupicka, Marek Orban
1Cardiocenter, Department of Cardiology, 3rd Medical School Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic. tousek@email.cz
Unlabelled:
The identification of viable myocardium after myocardial infarction (MI) carries major prognostic impact. Due to myocardial stunning early after successful mechanical reperfusion of acute myocardial infarction, analysis of myocardial perfusion but not of contractile function can be used to differentiate between necrotic and viable myocardium. Although being widely regarded as an indicator of infarct transmurality, the relation between post-infarct Q-wave formation and the amount of viable myocardium has not been studied. We hypothesized that there was a correlation between the extent of Q-wave formation and the extent of perfusion abnormalities on myocardial contrast echocardiography early after successful mechanical reperfusion of first acute myocardial infarction and that the extent of post-infarct Q-wave formation might therefore be used as a simple estimate of the amount of viable myocardium.
Methods And Results:
47 patients with first MI and treated by direct PCI were enrolled. Patients were divided into 3 groups according the presence and number of abnormal Q waves (group A-no abnormal Q wave; group B-< or =2 abnormal Q waves, group C-> or =3 abnormal Q waves). Left ventricular pump function was defined by ejection fraction (EF) on ventriculography and wall motion score index (WMSI) on echocardiography. Myocardial perfusion was defined by perfusion score index (PSI) on myocardial contrast echocardiography. Patients in group A had significantly better LV function than patients in other groups [EF 57+/-5 vs. 48+/-11% (group B) and 47+/-10% (group C); p<0.05], also WMSI was the best in this group [1.34+/-0.22 vs. 1.67+/-0.39 (group B) and 1.68+/-0.31 (group C); p<0.01]. Myocardial perfusion assessed by PSI was best in group A (1.2+/-0.3, p<0.05). With respect to PSI, there was a significant difference between group B and C (1.41+/-0.21 vs. 1.56+/-0.29; p<0.05), even though EF and WMSI did not differ in these groups. The amount of perfused segments with severe wall motion abnormality was higher in group B compared to group C (47% vs. 25%; p<0.05).
Conclusion:
In patients after successful mechanical reperfusion of first MI, the extent of Q-wave formation on ECG may be regarded as a corollary of the amount of myocardial microvascular damage and may, therefore, be used to estimate the amount of viable myocardium post-infarct.
Insights
Electrocardiogram Q-waves after myocardial infarction (MI) correlate with myocardial viability. Q-wave extent can estimate viable myocardium post-reperfusion, aiding prognosis after acute MI.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Assessing viable myocardium post-myocardial infarction (MI) is crucial for prognosis.
- Myocardial stunning affects contractile function early post-reperfusion, making perfusion analysis key for viability assessment.
- The relationship between Q-wave formation and viable myocardium post-MI has not been extensively studied.
Purpose of the Study:
- To investigate the correlation between Q-wave formation extent and perfusion abnormalities on myocardial contrast echocardiography.
- To determine if Q-wave extent can serve as a simple estimate of viable myocardium after acute MI.
Main Methods:
- 47 patients with first MI treated with direct percutaneous coronary intervention (PCI) were enrolled.
- Patients were grouped based on the presence and number of abnormal Q waves (0, 1-2, or >=3).
- Left ventricular function (ejection fraction, wall motion score index) and myocardial perfusion (perfusion score index) were assessed.
Main Results:
- Patients with no Q waves showed significantly better left ventricular function and myocardial perfusion.
- Significant differences in perfusion were observed between groups with 1-2 and >=3 Q waves, despite similar ejection fraction and wall motion.
- A higher proportion of severely impaired segments were perfused in patients with 1-2 Q waves compared to those with >=3 Q waves.
Conclusions:
- Q-wave formation extent after successful MI reperfusion correlates with myocardial microvascular damage.
- ECG Q-wave extent can be utilized as a practical estimation of viable myocardium post-infarct.
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