Natural course of the S-T segment and QRS complex in patients with acute anterior myocardial infarction

doi:10.1016/0002-9149(79)90040-7

The American Journal of Cardiology

Volume 43, Issue 1, January 1979, Pages 29-34

https://doi.org/10.1016/0002-9149(79)90040-7 Get rights and content

Abstract

Sums of the S-T segment elevation from the 35 lead precordial electrocardiographic map (∑ST₃₅) and Standard 6 lead precordial electrocardiogram (∑ST₆) were obtained from 20 patients after acute anterior myocardial infarction and the calculations repeated 2, 4, 12, 24, 48, 72 and 240 hours later. Q and R wave areas were summed (∑Q₃₅, ∑Q₆, ∑R₃₅ and ∑R₆). ∑ST₃₅ and ∑ST₆ values decreased significantly in patients without pericarditis 7 to 12 hours after the onset of symptoms (P < 0.02), but increased significantly from these reduced values 25 to 48 hours after the onset of symptoms. An increase in ∑ST₃₅ and ∑ST₆ (P < 0.05) occurred 13 to 24 hours after the onset of symptoms in four patients with pericarditis before a pericardial rub was heard. No significant change in ∑Q₃₅ occurred from the initial to the final map study; a decrease in ∑R₃₅ (P < 0.02) occurred only in a group of patients studied at or before 5 hours after initial symptoms. No correlation was found between the initial level of S-T segment elevation and subsequent change in Q or R wave areas except in two patients whose initial electrocardiographic studies were performed at or within 5 hours of initial symptoms. Good correlation was found between ∑ST₃₅ and ∑ST₆ (r = +0.906, P < 0.001), ∑Q₃₅ and ∑Q₆ (r = +0.864, P < 0.001), and ∑R₃₅ and ∑R₆ (r = +0.903, P < 0.001). The course of the S-T segment and QRS complex after anterior myocardial infarction depends on the time of study after initial symptoms. The Standard 6 lead precordial electrocardiogram may offer a practical alternative to the 35 lead map for patients with anterior myocardial infarction.

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Myocardial Infarction and Electrocardiographic Patterns Simulating Myocardial Infarction
2008, Chou's Electrocardiography in Clinical Practice: Adult and Pediatric
Relationship between myocardial viability and the predischarge electrocardiographic pattern in patients with first anterior wall acute myocardial infarction
2003, International Journal of Cardiology
Background: The assessment of residual viability in the infarcted area after an acute myocardial infarction is relevant to subsequent management and prognosis. Objective: The aim of this study was to investigate the correlation between myocardial viability after an acute anterior myocardial infarction (AMI) as assessed by low dose dobutamine stress echocardiography (LDDSE) and the electrocardiographic patterns of ST segment and T wave abnormalities at the end of the first week of the acute event. Methods: Sixty-nine consecutive patients (51 men, 18 women, mean age±standard deviation=57±11 years) who admitted to our clinic due to a first episode of transmural AMI were included in this study. Two-dimensional echocardiography was performed to all patients during rest and low dose dobutamine administration at the end of the first week of admission (7±2 days). Patients were classified into four groups according to ST segment and T wave morphology: group A, ST elevation ≤0.1 mV and negative T waves; group B, ST elevation ≤0.1 mV and positive T waves; group C, ST elevation ≥0.1 mV and negative T waves and group D, ST elevation ≥0.1 mV and positive T waves. Results: Myocardial viability was detected more often in patients with isoelectric ST segments (22/24, 92%) than those with elevated ST segments (21/45, 47%) (P<0.001). Similarly patients with negative T waves had myocardial viability more frequently compared to those with positive T waves (32/45, 71% vs. 11/24, 46%, P<0.01). Seventeen (94%) of 18 patients in group A and 5 (83%) of six patients in group B had viable myocardium (P>0.05). Myocardial viability was found in 15 (56%) of 27 patients in group C and six (33%) of 18 patients in group D (P<0.01). As a marker of viable myocardium, isoelectricity of ST segment was specific (92%) but only moderately sensitive (51%), with a 92% positive predictive accuracy and a poor (53%) negative predictive value. T wave negativity was less spesific but more sensitive than isoelectricity of ST segment for myocardial viability. Conclusion: The presence of isoelectric ST segment and negative T wave indicates a high probability of myocardial viablitiy. However, absence of these electrocardiographic patterns does not exclude the presence of viable myocardium.
ST-segment re-elevation unrelated to left ventricular ejection fraction or volume after anterior wall acute myocardial infarction treated with successful reperfusion
2002, Journal of Electrocardiology
Ventricular remodeling is a major determinant of the long-term prognosis of patients with acute myocardial infarction (AMI). No previous study examined the relation of ST-segment re-elevation to left ventricular (LV) volume and function in patients with successful reperfusion. We examined the relation of ST-segment re-elevation to LV function and volume indices in 51 patients with anterior wall AMI who underwent successful reperfusion by direct coronary angioplasty. A 12-lead electrocardiogram was recorded once a day until 7 days after the onset of AMI. ST-segment shift was measured and [Sigma ]ST was defined as the sum of ST-segment elevation obtained from leads V2, V3, and V4. ST-segment re-elevation was defined as present when the difference between maximal and minimal [Sigma ]ST ([utri ]ST) was [gt ]0.3mV. LV indices were obtained from left ventriculography performed approximately 1 month after the onset of AMI. ST-segment re-elevation was observed in 15 patients (29%). No significant differences were observed between the ST- re-elevation group and non[ndash ]ST-re-elevation group in LV ejection fraction (49.4[plusmn]14.0 vs. 51.2[plusmn]11.5%), LV end-systolic volume index (35.8[plusmn]13.1 vs. 33.8[plusmn]12.5 mL/m²) or LV end-diastolic volume index (69.7[plusmn]12.8 vs. 68.3[plusmn]14.4 mL/m²). The difference between maximal and minimal [Sigma ]ST ([utri ]ST) was not significantly correlated with any LV index examined. In conclusion, the present study revealed that ST-segment re-elevation after successful reperfusion in anterior wall AMI patients was not related to LV volume or function, indicating that ST-re-elevation is not a clinically meaningful indicator of LV remodeling.
Relation between evolutionary ST segment and T-wave direction and electrocardiographic prediction of mycardial infarct size and left ventricular function among patients with anterior wall q-wave acute myocardial infarction who received reperfusion therapy
2000, American Journal of Cardiology
Citation Excerpt :
In contrast, most of the previous studies have concentrated on ST-segment and T-wave dynamics within the first few hours of thrombolytic therapy, and found that rapid resolution of the ST-segment deviation and T-wave height, compared with the initial electrocardiogram10,11 and early inversion of the T waves,11,12 are associated with reperfusion or preservation of left ventricular function. However, many reports have demonstrated that in patients with AMI, the ST-T segments acquire a final configuration only 3 to 10 days after onset.13 We assume that our patients with isoelectric ST segment and negative T waves 3 to 10 days after AMI had successful and stable reperfusion with salvage of ischemic myocardium, and thus smaller final infarct size and better ejection fraction.
In the prethrombolytic era it was found that infarct size and left ventricular ejection fraction could be predicted using the Selvester QRS score. We evaluated whether infarct size and left ventricular ejection fraction could be predicted by the predischarge QRS score in patients who had received reperfusion therapy and whether considering the configuration of the ST segments and T waves would increase the accuracy of these predictions. We evaluated 51 patients with first anterior wall myocardial infarction who had received reperfusion therapy and predischarge resting technetium-99m-sestamibi scan. The electrocardiograms recorded on the same day of the scan were analyzed for the QRS score and were divided into 3 groups: A, isoelectric ST and negative T waves; B, ST elevation (≥0.1 mV) and negative T waves; and C, ST elevation (≥0.1 mV) and positive T waves. Groups A, B, and C included 12, 23, and 16 patients, respectively. The myocardial perfusion defect extent increased from groups A to C (median 21%, 37%, and 43.5% in groups A, B, and C, respectively; p = 0.023). Similarly, left ventricular ejection fraction decreased (44%, 38%, and 34%, respectively; p = 0.042) from groups A to C. Overall, the correlation between the QRS score and the myocardial perfusion defect extent (ρ 0.249; p = 0.08) and ejection fraction (ρ −0.229; p = 0.11) was poor. A statistically significant correlation between myocardial perfusion defect size and QRS score was found only in group A (ρ 0.599, p = 0.04). Among patients with anterior myocardial infarction who received reperfusion therapy, the predischarge QRS score was predictive of infarct size only in those in whom ST elevation resolved completely. In patients with residual ST elevation there was no correlation between QRS score and infarct size.
Development of ST-segment elevation and Q- and R-wave changes in acute myocardial infarction and the influence of thrombolytic therapy
1996, American Journal of Cardiology
Sequential electrocardiograms from admission to 36 hours in 358 patients with acute myocardial infarction (AMI) from the Pro-urokinase In Myocardial Infarction trial were assessed. The electrocardiogram was also examined at discharge in 69 of 358 patients. Patients underwent acute angiography, after which angioplasty was performed in most patients with impaired flow. The sum of the ST-segment deviation and Q- and R-wave voltages, and the QRS score were calculated and used for further evaluation. Development of Q waves, loss of R waves, and QRS score were completed within the first 9 hours after onset of AMI and remained stable thereafter. Reperfused patients had earlier stabilization and less severe electrocardiographic (ECG) abnormalities than nonreperfused patients. ST-segment elevation had already stabilized after 5 hours, was unchanged at 36 hours, and had significantly decreased at discharge. No significant ECG and clinical outcome differences were found between the Thrombolysis In Myocardial Infarction trial (TIMI) 2 and TIMI 3 patients. A 23.3% gain in ECG-estimated infarct size was found in the reperfusion group compared with a 12.0% gain in the nonreperfused group (p = 0.08). In summary, as early as 9 hours after onset of AMI, QRS changes were already complete. Thereafter, QRS morphology was stable. Thus, a QRS-based estimation of infarct size can be made as early as 9 hours after AMI. A similar ECG outcome for patients with TIMI 2 and 3 flow was found, which was significantly different from patients with TIMI 0 to 1 flow.
Clinical and angiographic correlates of normal creatine kinase with increased MB isoenzymes in possible acute myocardial infarction
1995, American Heart Journal
A retrospective study of patients with possible acute myocardial infarction was conducted over a 2-year period to evaluate the clinical characteristics, angiographic findings, and in-hospital prognosis in patients with normal total creatine kinase (CK) activity and increased MB isoenzyme activity (CK4MB). Thirty-nine cases were identified (study group) and compared with cases of Q-wave (n = 77) and non—Q-wave (n = 60) infarctions. Compared with the Q-wave group, study group patients were older (67.5 ± 9.0 vs 60.8 ± 11.5 years; p < 0.01) and more often had previous diagnoses of coronary disease (52.6% vs 18.2%; p < 0.01) and peripheral vascular disease (28.9% vs 10.4%; p = 0.02). Angina (92.2% vs 65.8%; p < 0.01) and ST elevation (81.8% vs 13.2%; p < 0.01) were more common in the Q-wave group. Nearly identical clinical profiles and electrocardiographic findings were observed in the study and non—Q-wave groups. Angiographic analysis revealed a higher frequency of multivessel disease in the study group (89.6%) than in the Q-wave group (48.6%, p < 0.01) but no difference between the study group and the non—Q-wave group (79.6%; p not statistically significant). Left ventricular function and inhospital complications were similar among groups. It is concluded that patients with normal total CK activity and increased CK-MB concentration represent a subgroup of patients with non—Q-wave infarction with a high prevalence of multivessel coronary disease.

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^☆: This study was supported in part by a Research Fellowship Grant from the Geresee Valley Heart Association, Rochester, New York and by Grant HL 05500 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.

^†: Present address: Cardiology Division, Wadsworth Veterans Administration Hospital, Los Angeles, California.

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Clinical studyNatural course of the S-T segment and QRS complex in patients with acute anterior myocardial infarction☆

Abstract

Am J Cardiol

Am J Cardiol

Am Heart J

Factors influencing infarct size following ex- perimental coronary artery occlusions

Circulation

Evaluation of precordial electrocardiographic mapping as a means of assessing changes in myocardial ischemic injury

Circulation

Use of changes in the epicardial QRS complex to assess interventions which modify the extent of myocardial necrosis following coronary artery occlusion

Circulation

Effects of intraaortic balloon counterpulsation on the severity of myocardial ischemic injury following acute coronary occlusion

Circulation

Reduction of experimental myocardial infarct size by corticosteroid administration

J Clin Invest

Effect of glucose-insulin-potassium infusion on myocardial infarction following experimental coronary artery occlusion

Circulation

ST-segment potentials and mapping. Theory and experiments

Circulation

ST-segment mapping. Realistic and unrealistic expectations

Circulation

Clinical study
Natural course of the S-T segment and QRS complex in patients with acute anterior myocardial infarction☆