BACKGROUND: The V-index is an ECG marker quantifying spatial heterogeneity of ventricular repolarization. We prospectively assessed the diagnostic and prognostic values of the V-index in patients with suspected non-ST-elevation myocardial infarction (NSTEMI). METHODS: We prospectively enrolled 497 patients presenting with suspected NSTEMI to the emergency department (ED). Digital 12-lead ECGs of five-minute duration were recorded at presentation. The V-index was automatically calculated in a blinded fashion. Patients with a QRS duration >120ms were ruled out from analysis. The final diagnosis was adjudicated by two independent cardiologists. The prognostic endpoint was all-cause mortality during 24months of follow-up. RESULTS: NSTEMI was the final diagnosis in 14% of patients. V-index levels were higher in patients with AMI compared to other causes of chest pain (median 23ms vs. 18ms, p<0.001). The use of the V-index in addition to conventional ECG-criteria improved the diagnostic accuracy for the diagnosis of NSTEMI as quantified by area under the ROC curve from 0.66 to 0.73 (p=0.001) and the sensitivity of the ECG for AMI from 41% to 86% (p<0.001). Cumulative 24-month mortality rates were 99.4%, 98.4% and 88.3% according to tertiles of the V-index (p<0.001). After adjustment for age and important ECG and clinical parameters, the V-index remained an independent predictor of death. CONCLUSIONS: The V-index, an ECG marker quantifying spatial heterogeneity of ventricular repolarization, significantly improves the accuracy and sensitivity of the ECG for the diagnosis of NSTEMI and independently predicts mortality during follow-up.
BACKGROUND: The V-index is an ECG marker quantifying spatial heterogeneity of ventricular repolarization. We prospectively assessed the diagnostic and prognostic values of the V-index in patients with suspected non-ST-elevation myocardial infarction (NSTEMI). METHODS: We prospectively enrolled 497 patients presenting with suspected NSTEMI to the emergency department (ED). Digital 12-lead ECGs of five-minute duration were recorded at presentation. The V-index was automatically calculated in a blinded fashion. Patients with a QRS duration >120ms were ruled out from analysis. The final diagnosis was adjudicated by two independent cardiologists. The prognostic endpoint was all-cause mortality during 24months of follow-up. RESULTS: NSTEMI was the final diagnosis in 14% of patients. V-index levels were higher in patients with AMI compared to other causes of chest pain (median 23ms vs. 18ms, p<0.001). The use of the V-index in addition to conventional ECG-criteria improved the diagnostic accuracy for the diagnosis of NSTEMI as quantified by area under the ROC curve from 0.66 to 0.73 (p=0.001) and the sensitivity of the ECG for AMI from 41% to 86% (p<0.001). Cumulative 24-month mortality rates were 99.4%, 98.4% and 88.3% according to tertiles of the V-index (p<0.001). After adjustment for age and important ECG and clinical parameters, the V-index remained an independent predictor of death. CONCLUSIONS: The V-index, an ECG marker quantifying spatial heterogeneity of ventricular repolarization, significantly improves the accuracy and sensitivity of the ECG for the diagnosis of NSTEMI and independently predicts mortality during follow-up.
Authors: Ivo Strebel; Raphael Twerenbold; Jasper Boeddinghaus; Roger Abächerli; Maria Rubini Giménez; Karin Wildi; Karin Grimm; Christian Puelacher; Patrick Badertscher; Zaid Sabti; Dominik Breitenbücher; Janina Jann; Farah Selman; Jeanne du Fay de Lavallaz; Nicolas Schaerli; Thomas Nestelberger; Claudia Stelzig; Michael Freese; Lukas Schumacher; Stefan Osswald; Christian Mueller; Tobias Reichlin Journal: Ann Noninvasive Electrocardiol Date: 2018-02-24 Impact factor: 1.468
Authors: Patrick Badertscher; Ivo Strebel; Ursina Honegger; Nicolas Schaerli; Deborah Mueller; Christian Puelacher; Max Wagener; Roger Abächerli; Joan Walter; Zaid Sabti; Lorraine Sazgary; Stella Marbot; Jeanne du Fay de Lavallaz; Raphael Twerenbold; Jasper Boeddinghaus; Thomas Nestelberger; Nikola Kozhuharov; Tobias Breidthardt; Samyut Shrestha; Dayana Flores; Carmela Schumacher; Damian Wild; Stefan Osswald; Michael J Zellweger; Christian Mueller; Tobias Reichlin Journal: Clin Res Cardiol Date: 2018-04-17 Impact factor: 5.460