ST-Segment Elevation in the Right Precordial Leads in Patients with Acute Anterior Myocardial Infarction
Leili Pourafkari1, Saeid Joudi1, Samad Ghaffari1
1Department of Cardiology, Tabriz University of Medical Sciences Cardiovascular Research Center, Tabriz, Iran.
Insights
ST segment elevation in leads V3R/V4R during anterior myocardial infarction does not predict prognosis. However, this finding was associated with a lower left ventricular ejection fraction, suggesting a potential role in long-term outcomes that requires further study.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- ST segment elevation in right precordial leads (V3R/V4R) is common in right ventricular myocardial infarction.
- Its presence in anterior ST-elevation myocardial infarction (STEMI) and prognostic implications are not well understood.
Purpose of the Study:
- To investigate the prognostic value of ST segment elevation in leads V3R/V4R in patients experiencing their first acute anterior myocardial infarction.
Main Methods:
- A prospective cohort study involving 111 patients with first-time anterior myocardial infarction.
- Patients were grouped based on the presence or absence of ST elevation in V3R/V4R.
- Data collected included demographics, biochemistry, echocardiography, and angiographic findings; in-hospital and 3-month outcomes (mortality, MACE, heart failure, ventricular dysrhythmia) were compared.
Main Results:
- ST elevation in V3R or V4R was observed in 64.9% of patients.
- No significant difference in proximal left anterior descending artery involvement between groups.
- Major adverse cardiac events and mortality rates were similar; however, left ventricular ejection fraction was significantly lower in patients with ST elevation in V3R/V4R (35%±8 vs. 38%±8, p=0.02).
Conclusions:
- ST segment elevation in V3R/V4R in anterior myocardial infarction does not appear to be a predictor of prognosis.
- A lower left ventricular ejection fraction in this subgroup may influence long-term outcomes, warranting further investigation.
Background:
Elevation of ST segment in leads V3R/ V4R, which is commonly encountered in right ventricular myocardial infarction, may also occur in patients with anterior ST elevation myocardial infarction (STEMI). However, the clinical impact of this finding in the setting of anterior myocardial infarction is not well understood.
Aims:
We aimed to investigate the prognostic value of ST segment elevation in leads V3R/V4R in patients with first acute anterior myocardial infarction.
Study Design:
Prospective cohort study.
Methods:
Right precordial leads V3R/V4R were recorded in 111 patients admitted with first time anterior myocardial infarction. Patients were allocated into two groups based on the presence or absence of ST elevation in leads V3R/V4R. Demographic, biochemical and echocardiographic data, as well as the angiographic information, were recorded. In-hospital and 3 month mortality, and major adverse cardiac events (MACE), death, heart failure and ventricular dysrhythmia were also compared.
Results:
ST elevation in lead V3R or V4R was present in 72 out of 111 patients (64.9%). Involvement of the proximal part of the left anterior descending (LAD) artery was not different in the two groups (44.4% of patients with elevation vs. 53.8% of patients without elevation, p=0.22). Post-myocardial infarction complications, mortality and major adverse cardiac events were similar in the two groups. Left ventricular ejection fraction (LVEF) was significantly lower in patients with ST elevation in V3R/V4R (35 %±8 vs. 38 %±8, p=0.02). Twenty three out of 111 patients (20.7%) developed heart failure, which was similar in the two groups [16 (22.2%) of patients with ST elevation vs. 7 (17.9%) of patients without ST elevation, p=0.39].
Conclusion:
Although ST elevation in V3R/V4R can be present in patients with left anterior descending artery occlusion, it does not seem to predict the prognosis. Lower left ventricular ejection fraction in this group may play a role in the long-term prognosis; however, this issue needs further investigation.
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