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Relationship of changes in QRS duration with left ventricular ejection fraction in patients with acute ST segment
1Department of Cardiology, Second Affiliated Hospital of Anhui Medical University, China.
Insights
Changes in QRS duration (△QRSd) after primary percutaneous coronary intervention (PPCI) can predict left ventricular systolic dysfunction (LVSD) in ST-segment elevation myocardial infarction (STEMI) patients. This aids in risk stratification and personalized treatment strategies.
Area of Science:
- Cardiology
- Electrophysiology
- Acute Myocardial Infarction
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring timely intervention.
- Primary percutaneous coronary intervention (PPCI) is the standard reperfusion therapy for STEMI.
- Left ventricular ejection fraction (LVEF) is a key indicator of cardiac function post-STEMI, but its prediction can be challenging.
Purpose of the Study:
- To evaluate the association between changes in QRS duration (△QRSd) and LVEF after PPCI in first-time STEMI patients.
- To identify predictors of left ventricular systolic dysfunction (LVSD) at 6 months post-discharge.
- To assess the efficacy of predictive models for LVEF changes.
Main Methods:
- A cohort of 244 STEMI patients treated with PPCI was analyzed.
- QRS duration (QRSd) and LVEF were assessed before and after PPCI.
- Least absolute shrinkage and selection operator (LASSO) regression and logistic regression were used for feature selection and prediction modeling.
Main Results:
- Postoperative QRSd and △QRSd were significantly higher in patients with LVSD.
- LASSO regression identified six key predictors of postoperative LVEF, including △QRSd.
- Logistic regression confirmed age, STB, NT-proBNP, baseline LVESV, △QRSd, and stent number as independent factors associated with LVSD.
Conclusions:
- △QRSd is a potential predictor of LVSD in STEMI patients post-PPCI.
- Developed models demonstrated good efficacy in predicting postoperative LVEF changes.
- Findings support the use of △QRSd for risk stratification and personalized management of STEMI patients.
Objective:
To assess the changes in QRS duration (△QRSd) before and after primary percutaneous coronary intervention(PPCI) regarding the relation of left ventricular ejection fraction (LVEF) in patients after a first acute ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI).
Methods:
A total of 244 patients with STEMI were enrolled, and clinical, biochemical, and angiographic parameters were compared between two groups based on LVEF at 6 months post-discharge. QRS duration (QRSd) was analyzed in relation to LVEF, and feature selection using least absolute shrinkage and selection operator(LASSO) regression was performed. Logistic regression analysis and receiver operating characteristic (ROC) curve evaluation were conducted to identify predictors and assess model efficacy.
Results:
Significant differences were observed between the two groups in terms of various parameters, including age, time from symptom onset to balloon dilation (STB), N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, Left ventricular end-diastolic volume(LVEDV) at baseline, left ventricular end-systolic volume(LVESV)at baseline, left ventricular end-diastolic diameter (LVDD)at baseline and six months, hospital length of stay(days), ST-segment resolution (STR), the left anterior descending artery as the infarction-related artery (IRA-LAD), frequency of TIMI 3 flow post PPCI, thrombus aspiration and/or intracoronary thrombolysis, the use of tirofiban, and the number of implanted stents(stents).In addition, postoperative QRSd and △QRSd were significantly higher in patients with left ventricular systolic dysfunction(LVSD). LASSO regression selected six variables as predictors of postoperative LVEF. Logistic regression analysis identified age, STB, NT-proBNP, LVESV at baseline,△QRSd, and stents, as independent factors associated with LVSD within six months for patients with a first occurrence of STEMI. The models achieved AUC values of 0.906 (using ΔQRSd),0.922(using 6 variables excluding ΔQRSd) and 0.962 (using 6 variables).
Conclusion:
This study identified ΔQRSd as a potential predictor of LVSD in patients with STEMI. The developed models showed good efficacy in predicting postoperative LVEF changes. These findings may contribute to risk stratification and individualized management strategies for STEMI patients.
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