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Diagnostic Performance of Selected Baseline Electrocardiographic Parameters for Prediction of Left Ventricular
Michał Kasprzak1, Tomasz Fabiszak1, Marek Koziński2
1Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. M. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland.
Insights
Baseline electrocardiographic (ECG) parameters have modest utility in predicting left ventricular remodeling (LVR) after ST-segment elevation myocardial infarction (STEMI). While some ECG markers showed initial promise, they were not independent predictors when considering biochemical data, body weight, and blood flow post-percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Medical Diagnostics
- Biomedical Engineering
Background:
- Left ventricular remodeling (LVR) is a significant complication following ST-segment elevation myocardial infarction (STEMI).
- Predicting LVR is crucial for guiding post-infarction management and improving patient outcomes.
- Baseline electrocardiography (ECG) is a readily available diagnostic tool that may offer predictive insights.
Purpose of the Study:
- To assess the diagnostic performance of baseline ECG parameters in predicting LVR in STEMI patients treated with primary percutaneous coronary intervention (PCI).
- To identify which ECG parameters, if any, are independent predictors of LVR six months post-STEMI.
Main Methods:
- A single-center cohort study including 249 STEMI patients treated with primary PCI.
- Evaluation of nine baseline ECG parameters for their association with LVR, defined as a >20% increase in left ventricular end-diastolic volume.
- Multivariate logistic regression analyses incorporating demographic, clinical, angiographic, and biochemical data.
Main Results:
- Univariate analysis identified several ECG parameters (e.g., number of leads with ST-segment elevation and Q-waves, sum and maximal ST-segment elevation) as potential predictors of LVR.
- In multivariate models including clinical and angiographic data, some ECG parameters remained predictive.
- However, after incorporating biochemical data, increasing body weight, suboptimal TIMI flow post-PCI, and higher myocardial necrosis biomarkers, rather than ECG parameters, were independently associated with LVR.
Conclusions:
- Baseline ECG parameters demonstrate only modest utility in predicting LVR six months after STEMI.
- The predictive value of ECG for LVR diminishes significantly when considering a broader range of clinical, biochemical, and procedural factors.
- Further research may be needed to identify more robust predictors of LVR in the STEMI population.
Abstract:
Objective: To evaluate the diagnostic performance of selected baseline electrocardiographic (ECG) parameters as predictors of left ventricular remodeling (LVR) in patients with a first ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Methods: The study was performed as a single-center cohort study, with 249 patients (74.7% males) included in the final analysis. Nine baseline ECG parameters were evaluated, with respect to occurrence of LVR 6 months after STEMI (defined as an echocardiography-assessed relative >20% increase in end-diastolic left ventricular volume compared with the value at discharge from hospital). Results: The baseline ECG predictors of LVR, identified in univariate analysis, included the number of leads with ST-segment elevation (odds ratio (OR) 1.19, 95% confidence interval (CI) 1.03-1.38, p = 0.0212), number of leads with Q-waves (OR 1.21, 95% CI 1.07-1.37, p = 0.0033), sum of ST-segment elevation (OR 1.04, 95% CI 1.00-1.08; p = 0.0253) and maximal ST-segment elevation (OR 1.14; 95% CI 1.00-1.29; p = 0.0446). When added to demographic, clinical and angiographic data, the number of leads with ST-segment elevation (OR 1.17, 95% CI 1.01-1.36; p = 0.0413), number of leads with Q-waves (OR 1.15, 95% CI 1.01-1.32; p = 0.0354) and the sum of ST-segment elevation (OR 1.04, 95% CI 1.00-1.08; p = 0.0331) successfully predicted development of LVR in multivariate logistic regression models. However, after inclusion of biochemical data in multivariate models, none of the electrocardiographic parameters, but increasing body weight, TIMI flow after PCI < 3 and higher maximal values of myocardial necrosis biomarker, was independently associated with the occurrence of LVR 6 months after STEMI. Conclusions: Our study demonstrates modest utility of pre-reperfusion ECG for the prediction of LVR occurrence after six months of STEMI.
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