Kenneth W Dodd1, Kendra D Elm2, Stephen W Smith2. 1. Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; Department of Internal Medicine, Hennepin County Medical Center, Minneapolis, Minnesota. 2. Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
Abstract
BACKGROUND: The modified Sgarbossa criteria have been validated as a rule for diagnosis of acute coronary occlusion (ACO) in left bundle branch block (LBBB). However, no analysis has been done on differences in the QRS complex, T-wave, or ST-segment concordance of < 1 mm in the derivation or validation studies. Furthermore, there was no comparison of patients with acute myocardial infarction (AMI) but without ACO (i.e., non-ST-elevation myocardial infarction [non-STEMI]) to patients with ACO or without AMI (no MI). OBJECTIVE: We compare findings involving the QRS amplitude, ST-segment morphology, ST-concordance < 1 mm, and T-waves in patients with LBBB with ACO, non-STEMI, and no MI. METHODS: Retrospectively, emergency department patients were identified with LBBB and ischemic symptoms but no MI, with angiographically proven ACO, and with non-STEMI. RESULTS: ACO, non-STEMI, and no MI groups consisted of 33, 24, and 105 patients. The sum of the maximum deflection of the QRS amplitude across all leads (ΣQRS) was smaller in patients with ACO than those without ACO (101.5 mm vs. 132.5 mm; p < 0.0001) and a cutoff of ΣQRS < 90 mm was 92% specific. For ACO, non-concave ST-segment morphology was 91% specific, any ST concordance ≥ 1 mm was 95% specific, and any ST concordance ≥ 0.5 mm was 94% sensitive. For non-STEMI, terminal T-wave concordance, analogous to biphasic T-waves, was moderately sensitive at 79%. CONCLUSIONS: We found differences in QRS amplitude, ST-segment morphology, and T-waves between patients with LBBB and ACO, non-STEMI, and no MI. However, none of these criteria outperformed the modified Sgarbossa criteria for diagnosis of ACO in LBBB.
BACKGROUND: The modified Sgarbossa criteria have been validated as a rule for diagnosis of acute coronary occlusion (ACO) in left bundle branch block (LBBB). However, no analysis has been done on differences in the QRS complex, T-wave, or ST-segment concordance of < 1 mm in the derivation or validation studies. Furthermore, there was no comparison of patients with acute myocardial infarction (AMI) but without ACO (i.e., non-ST-elevation myocardial infarction [non-STEMI]) to patients with ACO or without AMI (no MI). OBJECTIVE: We compare findings involving the QRS amplitude, ST-segment morphology, ST-concordance < 1 mm, and T-waves in patients with LBBB with ACO, non-STEMI, and no MI. METHODS: Retrospectively, emergency department patients were identified with LBBB and ischemic symptoms but no MI, with angiographically proven ACO, and with non-STEMI. RESULTS:ACO, non-STEMI, and no MI groups consisted of 33, 24, and 105 patients. The sum of the maximum deflection of the QRS amplitude across all leads (ΣQRS) was smaller in patients with ACO than those without ACO (101.5 mm vs. 132.5 mm; p < 0.0001) and a cutoff of ΣQRS < 90 mm was 92% specific. For ACO, non-concave ST-segment morphology was 91% specific, any ST concordance ≥ 1 mm was 95% specific, and any ST concordance ≥ 0.5 mm was 94% sensitive. For non-STEMI, terminal T-wave concordance, analogous to biphasic T-waves, was moderately sensitive at 79%. CONCLUSIONS: We found differences in QRS amplitude, ST-segment morphology, and T-waves between patients with LBBB and ACO, non-STEMI, and no MI. However, none of these criteria outperformed the modified Sgarbossa criteria for diagnosis of ACO in LBBB.
Authors: Radek Martinek; Radana Kahankova; Homer Nazeran; Jaromir Konecny; Janusz Jezewski; Petr Janku; Petr Bilik; Jan Zidek; Jan Nedoma; Marcel Fajkus Journal: Sensors (Basel) Date: 2017-05-19 Impact factor: 3.576
Authors: Andrea Di Marco; Marcos Rodriguez; Juan Cinca; Antoni Bayes-Genis; Jose T Ortiz-Perez; Albert Ariza-Solé; Jose Carlos Sanchez-Salado; Alessandro Sionis; Jany Rodriguez; Beatriz Toledano; Pau Codina; Eduard Solé-González; Monica Masotti; Joan Antoni Gómez-Hospital; Ángel Cequier; Ignasi Anguera Journal: J Am Heart Assoc Date: 2020-07-04 Impact factor: 5.501