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Predicting postinfarction left ventricular dysfunction based on the configuration of the QRS complex and ST segment
D Hasdai1, A Porter, Y Birnbaum
1Department of Cardiology, Beilinson Medical Center, Petah Tikva, Israel.
Insights
Patients with anterior wall acute myocardial infarction (AMI) showing specific ECG patterns (Pattern B) have a higher risk of developing left ventricular dysfunction (LVD). Early identification of this high-risk group is crucial for timely intervention.
Area of Science:
- Cardiology
- Medical Diagnostics
- Electrocardiography
Background:
- Left ventricular dysfunction (LVD) is a significant complication following acute myocardial infarction (AMI).
- Identifying patients at high risk for LVD after anterior wall AMI is critical for prognosis and management.
Purpose of the Study:
- To identify patients with anterior wall AMI at high risk of developing postinfarction left ventricular dysfunction (LVD).
Main Methods:
- Retrospective analysis of 81 patients admitted with anterior wall AMI.
- Classification of patients into two groups (Pattern A and Pattern B) based on QRS complex and ST segment configuration on initial ECG.
- Assessment of left ventricular ejection fraction (LVEF) during hospitalization to diagnose LVD (LVEF < 40%).
Main Results:
- LVD was significantly more prevalent in Pattern B patients (48%) compared to Pattern A patients (12%) (p = 0.002).
- No significant correlation was found between the number of leads with ST segment elevation and LVD (p = 0.47).
- A weak but significant negative correlation was observed between the sum of ST segment elevation and LVEF (R = -0.22, p < 0.05).
Conclusions:
- Patients with anterior wall AMI exhibiting Pattern B on their initial ECG are at a substantially higher risk of developing post-AMI LVD.
- ECG pattern analysis can aid in stratifying risk for LVD in anterior wall AMI patients.
Abstract:
The objective of the study was to identify patients with anterior wall acute myocardial infarction (AMI) at high risk of postinfarction left ventricular dysfunction (LVD). This study population included all patients admitted with a diagnosis of anterior wall AMI (ST segment elevation of > 1 mm in 2 or more precordial leads) without history or ECG evidence of antecedent AMI,who underwent assessment of left ventricular ejection fraction (LVEF) during emergency hospitalization. ST segment deviation from baseline was measured manually 0.08 s after the J point in all leads. Patients (n = 81) were classified into two groups based on the configuration of the QRS complex and ST segment: ST > 1 mm with preserved (pattern A; n = 60) or distorted terminal QRS (emergence of the J point at a level above the lower half of the R wave or disappearance of the S wave in leads with an Rs configuration; pattern B; n = 21). LVD (LVEF < 40%) was significantly more prevalent in patients with pattern B than pattern A (48 vs. 12%; p = 0.002). There was no correlation between the number of leads with ST segment elevation and LVD (p = 0.47). The sum of ST segment elevation in involved leads correlated weakly, yet significantly with LVEF (R = -0.22; p < 0.05). In conclusion, patients with anterior wall AMI and pattern B in the initial ECG are at high risk of post-AMILVD.