Correlation of Reciprocal Changes and QRS Amplitude in ECG to Left Ventricular Dysfunction, Wall Motion Score and
Silpita Katragadda1, Murali Alagesan2, Shanmugasundaram Rathakrishnan3
1Registrar, Department of Infectious Diseases, Apollo Health City Campus, Jubilee Hills, Hyderabad, Telangana, India.
Insights
Electrocardiogram (ECG) effectively predicts outcomes in ST Elevation Myocardial Infarction (STEMI). Reciprocal changes on ECG indicate poorer clinical outcomes, while lower QRS amplitude may predict larger infarct size.
Area of Science:
- Cardiology
- Medical Diagnostics
- Clinical Research
Background:
- Electrocardiogram (ECG) is a primary diagnostic tool for ST Elevation Myocardial Infarction (STEMI).
- 12-lead ECG also holds potential for prognostication in STEMI patients.
Purpose of the Study:
- To evaluate the prognostic value of ECG in predicting clinical outcomes.
- To assess ECG's role in identifying wall motion abnormalities in STEMI.
Main Methods:
- Prospective study of 114 STEMI patients (age >18) at PSG Institute of Medical Sciences and Research.
- ECG parameters including reciprocal changes and QRS amplitude were analyzed.
- Clinical outcomes, Left Ventricular Dysfunction (LVD), and wall motion scores were assessed at follow-up.
Main Results:
- Reciprocal changes on ECG were significantly associated with the development of LVD (p=0.002).
- Patients with Anterior Wall Myocardial Infarction (AWMI) and Inferior Wall Myocardial Infarction (IWMI) exhibiting reciprocal changes showed statistically significant associations with NYHA symptom classes.
- A statistically significant association was found between QRS amplitude and wall motion score (r=0.210), particularly in IWMI (r=-0.359, p=0.031).
Conclusions:
- ECG serves as a valuable prognostic tool in acute STEMI.
- The presence of reciprocal changes on ECG is indicative of poorer follow-up outcomes.
- Lower QRS amplitude can predict larger infarct size in STEMI patients.
Introduction:
Electrocardiogram (ECG) is the simplest tool for diagnosing ST Elevation Myocardial Infarction (STEMI). We can use a12 lead ECG for prognostication purposes also.
Aim:
The aim of the study was to find out the role of ECG as a prognostic marker in terms of clinical outcome and wall motion abnormality.
Materials And Methods:
It was a prospective study done in PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India, from January 2014 to September 2014. Patients aged above 18 years admitted with first episode of ST EMI as per the inclusion and exclusion criteria were recruited for the study. Presence of reciprocal changes and QRS amplitude was measured from ECG. Presence of Left Ventricular Dysfunction (LVD) and wall motion score were calculated from ECG along with clinical outcome during first follow up visit. Statistical analysis was done using SPSS software. Probability was calculated using chi-square test, independent t-test and ANOVA analysis.
Results:
A total of 120 patients were recruited for the study of which six were excluded based on the exclusion criteria. Among 114 patients analysed, 55 had reciprocal changes; 38 of them developed LVD which was statistically significant (p=0.002). Of the 78 patients with Anterior Wall Myocardial Infarction (AWMI), 35 had reciprocal changes; 15 (42.9%) of them had NYHA Class 1 symptoms, 14 (40%) had Class II and 4 (11%) had class III symptoms at follow up. The association was statistically significant (p=0.001). Similar statistically significant association was found in patients with Inferior Wall Myocardial Infarction (IWMI) who had reciprocal changes and NYHA symptoms at follow up (p=0.004). The mean wall motion score in patients with AWMI and reciprocal changes was 24.83 ± 4.1; whereas, without reciprocal changes was 23.98 ± 3.6; the association was not statistically significant. The mean QRS amplitude of all patients with LVD was 33.25 ±16.34. The association between QRS amplitude and LVD was not statistically significant. The overall mean wall motion score was 24.86 ± 3.91. The association between QRS amplitude and wall motion score was statistically significant (r value = 0.210). The association between QRS amplitude and wall motion score was statistically significant when we analysed AWMI (r= -0.147, p=0.199) and IWMI (r= -0.359, p=0.031) separately.
Conclusion:
ECG can be used as a tool for prognostication in acute STEMI. The presence of reciprocal changes in the ECG can signify poorer outcome on follow up. Lower QRS amplitude can be used as a predictor of larger infarct.
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