Maria Jose Valle-Caballero1, Rodrigo Fernández-Jiménez2, Raquel Díaz-Munoz3, Alonso Mateos4, Marta Rodríguez-Álvarez5, José A Iglesias-Vázquez6, Carmen Saborido5, Carolina Navarro7, M Luisa Dominguez7, Luisa Gorjón6, José C Fontoira6, Valentín Fuster8, Juan Carlos García-Rubira1, Borja Ibanez9. 1. Virgen Macarena University Hospital, Sevilla, Spain. 2. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Universitario Clínico San Carlos, Madrid, Spain. 3. Consultorio de Quijorna (Centro de Salud de Villanueva de la Cañada), Spain. 4. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Servicio de Urgencia Médica de Madrid (SUMMA112), Spain; Universidad Francisco de Vitoria, Madrid, Spain. 5. Complejo Hospitalario Universitario de Vigo-Meixoeiro, Pontevedra, Spain. 6. Servicio de Emergencia Médica 061 de Galicia, Spain. 7. Servicio de Urgencia Médica de Madrid (SUMMA112), Spain. 8. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, USA. 9. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; IIS, Fundación Jiménez Díaz Hospital, Madrid, Spain. Electronic address: bibanez@cnic.es.
Abstract
BACKGROUND: QRS distortion is an electrocardiographic (ECG) sign of severe ongoing ischemia in the setting of ST-segment elevation acute myocardial infarction (STEMI). We sought to evaluate the association between the degree of QRS distortion and myocardium at risk and final infarct size, measured by cardiac magnetic resonance (CMR). METHODS: A total of 174 patients with a first anterior STEMI reperfused by primary angioplasty were prospectively recruited. Pre-reperfusion ECG was used to divide the study population into three groups according to the absence of QRS distortion (D0) or its presence in a single lead (D1) or in 2 or more contiguous leads (D2+). Myocardium at risk and infarct size were determined by CMR one week after STEMI. Multiple regression analysis was used to study the association of QRS distortion with myocardium at risk and infarct size, with adjustment for relevant clinical and ECG variables. RESULTS: 101 patients (58%) were in group D0, 30 (17%) in group D1, and 43 (25%) in group D2+. Compared with group D0, presence of QRS distortion (groups D2+ and D1) was associated with a significantly adjusted larger extent of myocardium at risk (group D2+: absolute increase 10.4%, 95% CI 6.1-14.8%, p<0.001; group D1: absolute increase 3.3%, 95% CI 1.3-7.9%, p=0.157) and larger infarct size (group D2+: absolute increase 10.1%, 95% CI 5.5-14.7%, p<0.001; group D1: absolute increase 4.9%, 95% CI 0.08-9.8%, p=0.046). CONCLUSIONS: Distortion in the terminal portion of the QRS complex on pre-reperfusion ECG in two or more leads is independently associated with larger myocardium at risk and infarct size in the setting of primary angioplasty-reperfused anterior STEMI. QRS distortion in only one lead is independently associated with larger infarct size in this setting. Our findings suggest that QRS distortion analysis could be included in risk-stratification of patients presenting with anterior STEMI.
RCT Entities:
BACKGROUND: QRS distortion is an electrocardiographic (ECG) sign of severe ongoing ischemia in the setting of ST-segment elevation acute myocardial infarction (STEMI). We sought to evaluate the association between the degree of QRS distortion and myocardium at risk and final infarct size, measured by cardiac magnetic resonance (CMR). METHODS: A total of 174 patients with a first anterior STEMI reperfused by primary angioplasty were prospectively recruited. Pre-reperfusion ECG was used to divide the study population into three groups according to the absence of QRS distortion (D0) or its presence in a single lead (D1) or in 2 or more contiguous leads (D2+). Myocardium at risk and infarct size were determined by CMR one week after STEMI. Multiple regression analysis was used to study the association of QRS distortion with myocardium at risk and infarct size, with adjustment for relevant clinical and ECG variables. RESULTS: 101 patients (58%) were in group D0, 30 (17%) in group D1, and 43 (25%) in group D2+. Compared with group D0, presence of QRS distortion (groups D2+ and D1) was associated with a significantly adjusted larger extent of myocardium at risk (group D2+: absolute increase 10.4%, 95% CI 6.1-14.8%, p<0.001; group D1: absolute increase 3.3%, 95% CI 1.3-7.9%, p=0.157) and larger infarct size (group D2+: absolute increase 10.1%, 95% CI 5.5-14.7%, p<0.001; group D1: absolute increase 4.9%, 95% CI 0.08-9.8%, p=0.046). CONCLUSIONS: Distortion in the terminal portion of the QRS complex on pre-reperfusion ECG in two or more leads is independently associated with larger myocardium at risk and infarct size in the setting of primary angioplasty-reperfused anterior STEMI. QRS distortion in only one lead is independently associated with larger infarct size in this setting. Our findings suggest that QRS distortion analysis could be included in risk-stratification of patients presenting with anterior STEMI.
Authors: Jakob Almer; Viktor Elmberg; Josef Bränsvik; David Nordlund; Ardavan Khoshnood; Michael Ringborn; Marcus Carlsson; Ulf Ekelund; Henrik Engblom Journal: Ann Noninvasive Electrocardiol Date: 2018-09-28 Impact factor: 1.468
Authors: Rodrigo Fernández-Jiménez; Manuel Barreiro-Pérez; Ana Martin-García; Javier Sánchez-González; Jaume Agüero; Carlos Galán-Arriola; Jaime García-Prieto; Elena Díaz-Pelaez; Pedro Vara; Irene Martinez; Ivan Zamarro; Beatriz Garde; Javier Sanz; Valentin Fuster; Pedro L Sánchez; Borja Ibanez Journal: Circulation Date: 2017-07-07 Impact factor: 29.690
Authors: Raquel Díaz-Munoz; María José Valle-Caballero; Javier Sanchez-Gonzalez; Gonzalo Pizarro; Juan Carlos García-Rubira; Noemi Escalera; Valentin Fuster; Rodrigo Fernández-Jiménez; Borja Ibanez Journal: Basic Res Cardiol Date: 2021-07-19 Impact factor: 17.165