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Clinical Value of Limb-Lead R-Wave Amplitude in Predicting Cardiac Rupture After Acute Anterior Myocardial Infarction
Yongzhe Guo1, Yanling Huang1, Huizhong Lin1
1Department of Cardiology, Fujian Medical University Union Hospital, Fujian Cardiovascular Medicine Center, Fujian Institute of Coronary Artery Disease, Fujian Cardiovascular Research Center, Fujian Medical University Heart Center, Fuzhou, Fujian, People's Republic of China.
Insights
Reduced average R-wave voltage (AVRE) on ECG predicts cardiac rupture in acute anterior myocardial infarction with left ventricular aneurysm. This accessible measure aids risk stratification in high-risk patients.
Area of Science:
- Cardiology
- Electrocardiography
- Myocardial Infarction
Background:
- Cardiac rupture is a fatal complication of acute anterior myocardial infarction (AAMI), particularly in patients with left ventricular aneurysm (LVA).
- Identifying high-risk patients for cardiac rupture is crucial for timely intervention.
Purpose of the Study:
- To evaluate the predictive value of average R-wave voltage in limb leads (AVRE) for cardiac rupture in AAMI patients with LVA.
- To assess the utility of AVRE as a risk stratification tool in this specific population.
Main Methods:
- Retrospective single-center study of 249 AAMI patients undergoing primary PCI.
- Comparison of 63 patients with cardiac rupture (CR group) versus 186 without (Control group).
- AVRE measured on admission ECG; multivariate logistic regression and ROC analysis used for prediction.
Main Results:
- Patients with cardiac rupture had significantly lower AVRE (2.33 mV) than controls (3.33 mV).
- Reduced AVRE (<2.92 mV) was an independent predictor of cardiac rupture (OR: 0.682, p<0.01).
- AVRE showed significant predictive performance (AUC: 0.656) with 74.6% sensitivity and 59.7% specificity.
Conclusions:
- Reduced AVRE is an independent predictor of cardiac rupture in AAMI patients with LVA.
- AVRE serves as an accessible and valuable tool for risk stratification in this high-risk cohort.
Background:
Cardiac rupture remains a fatal complication of acute anterior myocardial infarction (AAMI), especially in the high-risk subset that develops left ventricular aneurysm (LVA). This study aimed to evaluate the predictive value of the average R-wave voltage in the electrocardiographic limb leads (AVRE) for cardiac rupture in this specific AAMI with LVA population.
Methods:
We conducted a retrospective, single-center study of 249 AAMI patients undergoing primary PCI, comparing 63 with cardiac rupture (CR group) to 186 without (Control group). Key inclusion criteria were typical chest pain and ST-segment elevation on ECG. AVRE was measured on admission ECG. Multivariate logistic regression and ROC curve analysis were used to identify independent predictors and assess the predictive performance of AVRE.
Results:
Patients with cardiac rupture had a significantly lower average limb-lead R-wave voltage (AVRE) than controls (2.33 vs 3.33 mV, p<0.001). Multivariate analysis identified AVRE and higher left ventricular ejection fraction (LVEF) as independent predictors (OR: 0.682 and 1.057, respectively; both p<0.01). The predictive performance of AVRE was significant (AUC: 0.656), with an optimal cutoff of <2.92 mV yielding a sensitivity of 74.6% and specificity of 59.7%.
Conclusion:
In this single-center study, a reduced AVRE (<2.92 mV) was an independent predictor of cardiac rupture in patients with AAMI and LVA, suggesting its potential as an accessible tool for risk stratification within this specific high-risk cohort.
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