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[Persistent ST segment elevation in anterior wall myocardial infarction: a sign of ventricular dysfunction]
J Costa Martorell1, C Piñero Gálvez
1Servicio de Cardiología y Unidad Coronaria, Hospital Universitario Virgen de la Macarena, Sevilla.
Insights
Persistent ST segment elevation after anterior myocardial infarction indicates worse left ventricular function, irrespective of ventricular aneurysm. Aneurysm presence was exclusive to the elevated ST segment group, highlighting its diagnostic significance.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Persistent ST segment elevation in anterior myocardial infarction was historically linked to ventricular aneurysm, a connection now debated.
- This study investigates the relationship between persistent ST elevation, left ventricular aneurysm, and cardiac function.
Purpose of the Study:
- To assess the association between persistent ST segment elevation and left ventricular aneurysm in patients with anterior myocardial infarction.
- To evaluate the impact of persistent ST segment elevation on left ventricular function (ejection fraction).
Main Methods:
- Cardiac catheterization was performed on 85 patients with chronic anterior wall myocardial infarction.
- Left ventricular ejection fraction and the presence of ventricular aneurysm were assessed.
- Findings were correlated with the persistence of ST segment elevation on electrocardiography.
Main Results:
- 66% of patients exhibited persistent ST segment elevation; 34% had an isoelectric ST segment.
- Left ventricular aneurysm was found in 57% of patients with elevated ST segments, but none with isoelectric ST segments.
- Ejection fraction was significantly lower in the elevated ST segment group (0.34 ± 0.13) compared to the isoelectric ST segment group (0.52 ± 0.11), irrespective of aneurysm presence.
Conclusions:
- Persistent ST segment elevation in anterior myocardial infarction is strongly associated with impaired left ventricular function.
- Left ventricular aneurysm is a common and exclusive finding in patients with persistent ST segment elevation.
- The degree of left ventricular dysfunction is independent of aneurysm presence, suggesting ST elevation as a marker of myocardial damage severity.
Background:
Persistent ST segment elevation in anterior myocardial infarction was classically attributed to ventricular aneurysm. This association is now considered controversial. To contribute to the elucidation of the problem, the association of this electrocardiographical finding with left ventricular aneurysm and function was assessed.
Methods:
In the catheterization studies of 85 patients with chronic anterior wall myocardial infarction the left ventricular function (ejection fraction) and the possible presence of ventricular aneurysm were investigated. These findings were correlated with the persistence of ST segment elevation.
Results:
56 of the 85 patients (66%) had persistent ST segment elevation, and 29 (34%) had isoelectric ST segment. 32 cases of left ventricular aneurysm were detected in the group with elevated ST segment (57%) and none in the group with isoelectric ST segment. The ejection fraction was markedly depressed in the group with elevated ST segment (0.34 +/- 0.13) in contrast with the group with isoelectric ST segment (0.52 +/- 0.11) (p less than 0.001). This abnormality in ventricular function was independent from the presence or absence of aneurysm (ejection fraction 0.34 +/- 0.12 vs 0.35 +/- 0.14).
Conclusions:
The persistent ST segment elevation is associated with a greater left ventricular function depression, independently from the presence of aneurysm, which is a common finding and exclusive of the group with persistently elevated ST segment.