Martin Reindl1, Sebastian Johannes Reinstadler1, Hans-Josef Feistritzer1, Lea Niess1, Constantin Koch1, Agnes Mayr2, Gert Klug1, Bernhard Metzler3. 1. University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. 2. University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. 3. University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. Electronic address: Bernhard.Metzler@tirol-kliniken.at.
Abstract
BACKGROUND: Persistent T-wave inversion (PTI) after ST-elevation myocardial infarction (STEMI) is associated with worse clinical outcome; however, the underlying mechanism between PTI and poor prognosis is incompletely understood. We sought to investigate the relationship between PTI and myocardial damage assessed by cardiac magnetic resonance (CMR) following STEMI. METHODS: In this prospective observational study, we included 142 consecutive revascularized STEMI patients. Electrocardiography to determine the presence and amplitude of PTI and pathological Q-waves was conducted 4months after infarction. CMR was performed within 1week after infarction and at 4months follow-up to evaluate infarct characteristics and myocardial function. RESULTS: Patients with PTI (n=103, 73%) showed a larger acute (21[11-29] vs. 6[1-13]%; p<0.001) and chronic infarct size (IS) (14[8-19] vs. 3[1-8]%; p<0.001) and more frequently microvascular obstruction (59 vs. 33%; p=0.02). The association between PTI and chronic IS remained significant (odds ratio: 9.02, 95%CI 3.49-23.35; p<0.001) after adjustment for pathological Q-wave and other IS estimators (high-sensitivity cardiac troponin T and C-reactive protein, N-terminal pro B-type natriuretic peptide, culprit vessel, pre-interventional TIMI flow). The value of PTI amplitude for the prediction of large chronic IS>11% (AUC: 0.84, 95%CI 0.77-0.90) was significantly higher compared to Q-wave amplitude (AUC: 0.72, 95%CI 0.63-0.80; p=0.009); the combination of PTI with pathological Q-wave (Q-wave/T-wave score) led to a net reclassification improvement of 0.43 (95% CI 0.29-0.57; p<0.001) as compared to PTI alone. CONCLUSIONS: PTI following STEMI is independently and incrementally associated with more extensive myocardial damage as visualized by CMR. An electrocardiographic score combining PTI with pathological Q-wave allows for a highly accurate IS estimation post-STEMI.
BACKGROUND: Persistent T-wave inversion (PTI) after ST-elevation myocardial infarction (STEMI) is associated with worse clinical outcome; however, the underlying mechanism between PTI and poor prognosis is incompletely understood. We sought to investigate the relationship between PTI and myocardial damage assessed by cardiac magnetic resonance (CMR) following STEMI. METHODS: In this prospective observational study, we included 142 consecutive revascularized STEMI patients. Electrocardiography to determine the presence and amplitude of PTI and pathological Q-waves was conducted 4months after infarction. CMR was performed within 1week after infarction and at 4months follow-up to evaluate infarct characteristics and myocardial function. RESULTS:Patients with PTI (n=103, 73%) showed a larger acute (21[11-29] vs. 6[1-13]%; p<0.001) and chronic infarct size (IS) (14[8-19] vs. 3[1-8]%; p<0.001) and more frequently microvascular obstruction (59 vs. 33%; p=0.02). The association between PTI and chronic IS remained significant (odds ratio: 9.02, 95%CI 3.49-23.35; p<0.001) after adjustment for pathological Q-wave and other IS estimators (high-sensitivity cardiac troponin T and C-reactive protein, N-terminal pro B-type natriuretic peptide, culprit vessel, pre-interventional TIMI flow). The value of PTI amplitude for the prediction of large chronic IS>11% (AUC: 0.84, 95%CI 0.77-0.90) was significantly higher compared to Q-wave amplitude (AUC: 0.72, 95%CI 0.63-0.80; p=0.009); the combination of PTI with pathological Q-wave (Q-wave/T-wave score) led to a net reclassification improvement of 0.43 (95% CI 0.29-0.57; p<0.001) as compared to PTI alone. CONCLUSIONS: PTI following STEMI is independently and incrementally associated with more extensive myocardial damage as visualized by CMR. An electrocardiographic score combining PTI with pathological Q-wave allows for a highly accurate IS estimation post-STEMI.
Authors: Martin Reindl; Sebastian Johannes Reinstadler; Christina Tiller; Hans-Josef Feistritzer; Markus Kofler; Alexandra Brix; Agnes Mayr; Gert Klug; Bernhard Metzler Journal: Eur Radiol Date: 2018-12-13 Impact factor: 5.315
Authors: Martin Reindl; Christina Tiller; Magdalena Holzknecht; Ivan Lechner; Nicolas Hein; Mathias Pamminger; Benjamin Henninger; Agnes Mayr; Hans-Josef Feistritzer; Gert Klug; Axel Bauer; Bernhard Metzler; Sebastian J Reinstadler Journal: J Am Heart Assoc Date: 2020-01-31 Impact factor: 5.501
Authors: Christina Tiller; Martin Reindl; Sebastian Johannes Reinstadler; Magdalena Holzknecht; Michael Schreinlechner; Alexander Peherstorfer; Nicolas Hein; Ivan Lechner; Agnes Mayr; Gert Klug; Bernhard Metzler Journal: BMC Cardiovasc Disord Date: 2019-12-09 Impact factor: 2.298
Authors: Christina Tiller; Magdalena Holzknecht; Martin Reindl; Ivan Lechner; Verena Kalles; Felix Troger; Johannes Schwaiger; Agnes Mayr; Gert Klug; Christoph Brenner; Axel Bauer; Bernhard Metzler; Sebastian Johannes Reinstadler Journal: Open Heart Date: 2021-02
Authors: Tiia Istolahti; Leo-Pekka Lyytikäinen; Heini Huhtala; Tuomo Nieminen; Mika Kähönen; Terho Lehtimäki; Markku Eskola; Ismo Anttila; Antti Jula; Harri Rissanen; Kjell Nikus; Jussi Hernesniemi Journal: Ann Noninvasive Electrocardiol Date: 2020-09-25 Impact factor: 1.468