1
|
Schmitz T, Wein B, Methe H, Linseisen J, Heier M, Peters A, Meisinger C. Association between admission ECG changes and long-term mortality in patients with an incidental myocardial infarction: Results from the KORA myocardial infarction registry. Eur J Intern Med 2022; 100:69-76. [PMID: 35317964 DOI: 10.1016/j.ejim.2022.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND The aim of this study was to examine the predictive value of specific changes in admission ECG on long-term outcome in acute myocardial infarction (AMI). METHODS From 2000 until 2017 all AMI cases (n = 9,689) in the study area of Augsburg, Germany, were prospectively recorded. For this study, all patients with a first-time AMI, who survived the first 28 days, were considered. Median observational time was 6.7 years (IQR: 3.6-10.9). Each case was assigned to one of the following groups according to the admission ECG: 'ST-segment elevation', 'ST-segment depression', 'T-wave inversion', 'unspecific changes', 'normal ECG' and 'bundle branch block' (BBB). Multivariable adjusted COX regression models were calculated to compare long-term all-cause mortality. RESULTS The final regression model revealed a significantly higher mortality among patients with BBB (HR: 1.52 [1.34-1.73], p-value: < 0.001) and 'ST-segment depression' (HR: 1.16 [1.03-1.29], p-value: 0.01252) compared to the STEMI group (reference group). The 'normal ECG' group (HR: 0.76 [0.66-0.87], p-value: < 0.001) on the other hand was associated with significantly lower long-term mortality. The 'T-wave inversion' group (HR: 1.08 [0.96-1.21]) and the 'unspecific changes' group (HR: 1.05 [0.94-1.17]) did not differ significantly from the STEMI group. CONCLUSION ST-segment depressions and BBB admission ECGs go along with higher long-term mortality in AMI patients compared to STEMI cases. This should be taken into account by physicians when treating patients with NSTEMIs. Only the complete absence of AMI-related ECG changes predicts a more favorable outcome.
Collapse
Affiliation(s)
- Timo Schmitz
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany.
| | - Bastian Wein
- Department of Cardiology, University Hospital of Augsburg, Germany
| | - Heiko Methe
- Department of Cardiology, Kliniken an der Paar, Krankenhaus Aichach, Aichach, Germany
| | - Jakob Linseisen
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany; IRG Clinical Epidemiology, Helmholtz Zentrum München, Germany
| | - Margit Heier
- KORA Study Centre, University Hospital of Augsburg, Germany; Institute of Epidemiology, Helmholtz Zentrum München, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Germany; German Center for Diabetes Research (DZD) Neuherberg, Germany
| | - Christa Meisinger
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany
| |
Collapse
|
2
|
Schmitz T, Thilo C, Linseisen J, Heier M, Peters A, Kuch B, Meisinger C. Admission ECG changes predict short term-mortality after acute myocardial infarction less reliable in patients with diabetes. Sci Rep 2021; 11:6307. [PMID: 33737645 PMCID: PMC7973741 DOI: 10.1038/s41598-021-85674-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/02/2021] [Indexed: 11/25/2022] Open
Abstract
Prior studies examined association between short-term mortality and certain changes in the admission ECG in acute myocardial infarction (AMI). Nevertheless, little is known about possible differences between patients with diabetes and without diabetes in this regard. So the aim of the study was to investigate the association between 28-day case fatality according to certain ECG changes comparing AMI cases with and without diabetes from the general population. From 2000 until 2017 a total of 9756 AMI cases was prospectively recorded in the study Area of Augsburg, Germany. Each case was assigned to one of the following groups according to admission ECG: ‘ST-elevation’, ‘ST-depression’, ‘only T-negativity’, ‘predominantly bundle branch block’, ‘unspecific changes’ and ‘normal ECG’ (the last two were put together for regression analyses). Multivariable adjusted logistic regression models were calculated to compare 28-day case-fatality between the ECG groups for the total sample and separately for diabetes and non-diabetes cases. For the non-diabetes group, the parsimonious logistic regression model revealed significantly better 28-day-outcome for the ‘normal ECG / unspecific changes’ group (OR: 0.47 [0.29–0.76]) compared to the reference group (STEMI). Contrary, in AMI cases with diabetes the category ‘normal ECG / unspecific changes’ was not significantly associated with lower short-term mortality (OR: 0.87 [0.49–1.54]). Neither of the other ECG groups was significantly associated with 28-day-mortality in the parsimonious logistic regression models. Consequently, the absence of AMI-typical changes in the admission ECG predicts favorable short-term mortality only in non-diabetic cases, but not so in patients with diabetes.
Collapse
Affiliation(s)
- Timo Schmitz
- MONIKA/KORA Myocardial Infarction Registry, University Hospital of Augsburg, Augsburg, Germany. .,Chair of Epidemiology, LMU München at UNIKA-T Augsburg, Augsburg, Germany.
| | - Christian Thilo
- Department of Cardiology, University Hospital of Augsburg, Augsburg, Germany
| | - Jakob Linseisen
- Chair of Epidemiology, LMU München at UNIKA-T Augsburg, Augsburg, Germany.,IRG Clinical Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Margit Heier
- KORA Study Centre, University Hospital of Augsburg, Augsburg, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Bernhard Kuch
- Department of Internal Medicine, Hospital Nördlingen, Nördlingen, Germany
| | - Christa Meisinger
- Chair of Epidemiology, LMU München at UNIKA-T Augsburg, Augsburg, Germany.,IRG Clinical Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| |
Collapse
|
3
|
Ranjbar A, Sohrabi B, Sadat-Ebrahimi SR, Ghaffari S, Kazemi B, Aslanabadi N, Seyvani B, Hajizadeh R. The association between T wave inversion in leads with ST-elevation and patency of the infarct-related artery. BMC Cardiovasc Disord 2021; 21:27. [PMID: 33435890 PMCID: PMC7802195 DOI: 10.1186/s12872-021-01851-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/04/2021] [Indexed: 11/24/2022] Open
Abstract
Background Up to over half of the patients with ST-segment elevation myocardial infarction (STEMI) are reported to undergo spontaneous reperfusion without therapeutic interventions. Our objective was to evaluate the applicability of T wave inversion in electrocardiography (ECG) of patients with STEMI as an indicator of early spontaneous reperfusion. Methods In this prospective study, patients with STEMI admitted to a tertiary referral hospital were studied over a 3-year period. ECG was obtained at the time of admission and patients underwent a PPCI. The association between early T wave inversion and patency of the infarct-related artery was investigated in both anterior and non-anterior STEMI. Results Overall, 1025 patients were included in the study. Anterior STEMI was seen in 592 patients (57.7%) and non-anterior STEMI in 433 patients (42.2%). Among those with anterior STEMI, 62 patients (10.4%) had inverted T and 530 (89.6%) had positive T waves. In patients with anterior STEMI and inverted T waves, a significantly higher TIMI flow was detected (p value = 0.001); however, this relationship was not seen in non-anterior STEMI. Conclusion In on-admission ECG of patients with anterior STEMI, concomitant inverted T wave in leads with ST elevation could be a proper marker of spontaneous reperfusion of infarct related artery.
Collapse
Affiliation(s)
| | - Bahram Sohrabi
- Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | | | - Samad Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Babak Kazemi
- Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Naser Aslanabadi
- Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Babak Seyvani
- Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Reza Hajizadeh
- Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran.
| |
Collapse
|
4
|
Koivula K, Konttila KK, Eskola MJ, Martiskainen M, Huhtala H, Virtanen VK, Mikkelsson J, Järvelä K, Niemelä KO, Karhunen PJ, Nikus KC. Long-term outcome of pre-specified ECG patterns in acute coronary syndrome. J Electrocardiol 2020; 62:178-183. [PMID: 32950774 DOI: 10.1016/j.jelectrocard.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Long-term outcome of real-life acute coronary syndrome (ACS) patients with selected ECG patterns is not well known. PURPOSE To survey the 10-year outcome of pre-specified ECG patterns in ACS patients admitted to a university hospital. METHODS A total of 1184 consecutive acute coronary syndrome patients in 2002-2003 were included and followed up for 10 years. The patients were classified into nine pre-specified ECG categories: 1) ST elevation; 2) pathological Q waves without ST elevation; 3) left bundle branch block (LBBB); 4) right bundle branch block (RBBB) 5) left ventricular hypertrophy (LVH) without ST elevation except in leads aVR and/or V1; 6) global ischemia ECG (ST depression ≥0.5 mm in 6 leads, maximally in leads V4-5 with inverted T waves and ST elevation ≥0.5 mm in lead aVR); 7) other ST depression and/or T wave inversion; 8) other findings and 9) normal ECG. RESULTS Any abnormality in the ECG, especially Q waves, LBBB, LVH and global ischemia, had negative effect on outcome. In age- and gender adjusted Cox regression analysis, pathological Q waves (HR 2.28, 95%CI 1.20-4.32, p = .012), LBBB (HR 3.25, 95%CI 1.65-6.40, p = .001), LVH (HR 2.53, 95%CI 1.29-4.97, p = .007), global ischemia (HR 2.22, 95%CI 1.14-4.31, p = .019) and the combined group of other findings (HR 3.01, 95%CI 1.56-6.09, p = .001) were independently associated with worse outcome. CONCLUSIONS During long-term follow-up of ACS patients, LBBB, ECG-LVH, global ischemia, and Q waves were associated with worse outcome than a normal ECG, RBBB, ST elevation or ST depression with or without associated T-wave inversion. LBBB was associated with the highest mortality rates.
Collapse
Affiliation(s)
- Kimmo Koivula
- Faculty of Medicine and Health Technology, Tampere University, Finland; South Karelia Central Hospital, Finland.
| | - Kaari K Konttila
- Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Markku J Eskola
- Heart Center, Department of Cardiology, Tampere University Hospital, Finland
| | | | - Heini Huhtala
- Faculty of Social Sciences, University of Tampere, Finland
| | - Vesa K Virtanen
- Heart Center, Department of Cardiology, Tampere University Hospital, Finland
| | | | - Kati Järvelä
- Heart Center, Tampere University Hospital, Finland
| | - Kari O Niemelä
- Heart Center, Department of Cardiology, Tampere University Hospital, Finland
| | - Pekka J Karhunen
- Faculty of Medicine and Health Technology, Tampere University, Finland; Fimlab Laboratories Tampere University Hospital, Tampere, Finland
| | - Kjell C Nikus
- Faculty of Medicine and Health Technology, Tampere University, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Finland
| |
Collapse
|
5
|
Predictive Value of Serial ECGs in Patients with Suspected Myocardial Infarction. J Clin Med 2020; 9:jcm9072303. [PMID: 32698466 PMCID: PMC7408822 DOI: 10.3390/jcm9072303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022] Open
Abstract
The electrocardiogram (ECG) is an important diagnostic tool for patients with suspected acute myocardial infarction (AMI). Current guidelines recommend serial ECGs in case of persisting symptoms. We aimed to analyze the predictive value of ischemic ECG-signs in patients with suspected AMI. Patients presenting to the emergency department with suspected AMI were included. All patients with ST-elevation AMI were excluded from analyses. Patients received 12-lead-ECG and high-sensitive Troponin T (hs-TnT)-measurement at admission and after 3 h. Four groups were defined: no ischemic signs in either ECG; new ischemic signs in the second ECG; resolved ischemic signs in the second ECG; and persistent ischemic signs in both ECGs. Patients were followed for 2 years to assess the composite endpoint of all-cause-mortality, AMI, and coronary revascularization. Using a 30-day landmark analysis, a Cox regression with ischemic signs as the variable of interest, adjusted by cardiovascular risk factors, was calculated. Of 1675 patients, 1321 showed no ischemic signs, in 25 new-, in 92 resolved- and in 237 patients, persistent ischemic signs were documented. Patients with persistent ischemic signs had significantly worse outcomes, compared to those without. Compared to no ischemic signs, adjusted hazard ratios for the combined endpoint were 0.81 (95% CI 0.20, 3.31; p-value = 0.77) for new-, 0.59 (95% CI 0.26, 1.34; p-value = 0.21) for resolved-, and 1.47 (95% CI 1.102, 2.13; p-value = 0.041) for persistent ischemic signs. In patients with suspected AMI, persistent ischemic ECG-signs are predictive of a higher rate of all-cause-mortality, AMI, and revascularization.
Collapse
|
6
|
Chen PF, Tang L, Pei JY, Yi JL, Xing ZH, Fang ZF, Zhou SH, Hu XQ. Prognostic value of admission electrocardiographic findings in non-ST-segment elevation myocardial infarction. Clin Cardiol 2020; 43:574-580. [PMID: 32125713 PMCID: PMC7299002 DOI: 10.1002/clc.23349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/24/2020] [Accepted: 02/14/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Admission electrocardiographic (ECG) findings of non-ST-segment elevation myocardial infarction (NSTEMI) include transient ST-segment elevation (TSTE), ST-segment depression (STD), T-wave inversion (TWI), and no ischemic changes (NIC). HYPOTHESIS This study aimed to assess the prognostic value of qualitative ECG findings at presentation and to clarify the influence of invasive treatment on the prognostic value of admission ECG findings. METHODS We analyzed the Acute Coronary Syndrome Quality Improvement in Kerala (ACS QUIK) study post hoc. NSTEMI patients were included and classified into four groups per ECG findings. Study endpoints were in-hospital and 30-day mortality rates and major adverse events (MAE). We performed multivariate logistic regression, adjusting for covariates in the Global Registry of Acute Coronary Events risk model, with subset analyses of patients treated with or without invasive management. RESULTS STD patients had significantly higher in-hospital and 30-day mortality rates/MAE than TWI patients, which had lower in-hospital mortality rate/MAE than the NIC group. TSTE patients had intermediate outcomes. In multivariate logistic regression using the TWI group as the reference, STD and NIC remained independently associated with worse outcomes. Subset analysis showed prognostic value of admission ECG in non-invasively managed but not in invasively managed patients. CONCLUSIONS STD was associated with adverse outcomes, TWI with benign prognoses. NIC should not be taken to indicate low risk. Qualitative analysis of admission ECG is suitable for rapid risk stratification of NSTMI patients at presentation. However, it may not be predictive of short-term outcomes of NSTEMI patients after invasive management.
Collapse
Affiliation(s)
- Peng-Fei Chen
- Department of Cardiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Liang Tang
- Department of Cardiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Jun-Yu Pei
- Department of Cardiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Jun-Lin Yi
- Department of Cardiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhen-Hua Xing
- Department of Cardiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhen-Fei Fang
- Department of Cardiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Sheng-Hua Zhou
- Department of Cardiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Xin-Qun Hu
- Department of Cardiology, Second Xiangya Hospital of Central South University, Changsha, China
| |
Collapse
|
7
|
Associations between ECG changes and echocardiographic findings in patients with acute non-ST elevation myocardial infarction. J Electrocardiol 2018; 51:188-194. [DOI: 10.1016/j.jelectrocard.2017.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Indexed: 11/18/2022]
|
8
|
Dr. Galen Wagner (1939-2016) as an Academic Writer: An Overview of his Peer-reviewed Scientific Publications. J Electrocardiol 2017; 50:47-73. [DOI: 10.1016/j.jelectrocard.2016.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
9
|
Sarak B, Goodman SG, Yan RT, Tan MK, Steg PG, Tan NS, Fox KAA, Udell JA, Brieger D, Welsh RC, Gale CP, Yan AT. Prognostic value of dynamic electrocardiographic T wave changes in non-ST elevation acute coronary syndrome. Heart 2016; 102:1396-402. [DOI: 10.1136/heartjnl-2015-309161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/24/2016] [Indexed: 02/07/2023] Open
|
10
|
Birnbaum Y, Nikus K, Kligfield P, Fiol M, Barrabés JA, Sionis A, Pahlm O, Niebla JG, de Luna AB. The role of the ECG in diagnosis, risk estimation, and catheterization laboratory activation in patients with acute coronary syndromes: a consensus document. Ann Noninvasive Electrocardiol 2015; 19:412-25. [PMID: 25262661 DOI: 10.1111/anec.12196] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The electrocardiogram (ECG) is the most widely used imaging tool helping in diagnosis and initial management of patients presenting with symptoms compatible with acute coronary syndrome. Acute ischemia affects the configuration of the QRS complexes, the ST segments and the T waves. The ECG should be read along with the clinical assessment of the patient. ST segment elevation (and ST depression in leads V1 -V3 ) in patients with active symptoms usually indicates acute occlusion of an epicardial artery with ongoing transmural ischemia. These patients should be triaged for emergent reperfusion therapy per current guidelines. However, many patients have ST segment elevation secondary to nonischemic causes. ST depression in leads other than V1 -V3 usually are indicative of subendocardial ischemia secondary to subocclusion of the epicardial artery, distal embolization to small arteries or spasm supply/demand mismatch. ST depression may also be secondary to nonischemic etiologies, such as left ventricular hypertrophy, cardiomyopathies, etc. Knowing the clinical scenario, comparison to previous ECG and subsequent ECGs (in cases that there are changes in the quality or severity of symptoms) may add in the diagnosis and interpretation in difficult cases. This review addresses the different ECG patterns, typically seen in patients with active symptoms, after resolution of symptoms and the significance of such changes when seen in asymptomatic patients.
Collapse
Affiliation(s)
- Yochai Birnbaum
- The Section of Cardiology, The Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Hasturk H, Abdallah R, Kantarci A, Nguyen D, Giordano N, Hamilton J, Van Dyke TE. Resolvin E1 (RvE1) Attenuates Atherosclerotic Plaque Formation in Diet and Inflammation-Induced Atherogenesis. Arterioscler Thromb Vasc Biol 2015; 35:1123-33. [PMID: 25792445 PMCID: PMC4415167 DOI: 10.1161/atvbaha.115.305324] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 03/08/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Epidemiological and recent clinical studies implicate periodontitis as an independent risk factor for cardiovascular disease. Previously, we demonstrated that rabbits with experimental periodontitis and cholesterol diet exhibit more aortic plaque compared with diet alone. We also showed that a proresolution mediator, Resolvin E1 (RvE1), reverses the experimental periodontitis. Here, we determined whether oral/topical application of RvE1 attenuates aortic atherosclerosis induced by both diet and periodontal inflammation. APPROACH AND RESULTS Thirty-nine rabbits on a 13-week regimen of 0.5% cholesterol diet were included. Periodontitis was induced by Porphyromonas gingivalis in 24 rabbits and 15 rabbits were placed in no-periodontitis groups. Interventions were no-treatment, vehicle, and RvE1 treatment (4 μg/site or 0.4 μg/site) topically applied 3× per week. At 13 weeks, both periodontitis and atherosclerosis were quantified. Atherosclerotic plaques were assessed by Sudan IV staining, histology, and ex vivo MRI. Serum levels of C-reactive protein were evaluated as a measure of systemic inflammation. RvE1, used as an oral/topical agent, significantly diminished atherogenesis and prevented periodontitis (P<0.05). In the absence of periodontal inflammation, oral/topical application of RvE1 resulted in significantly less arterial plaque, a lower intima/media ratio, and decreased inflammatory cell infiltration compared with no-treatment (P<0.001). Local oral RvE1 application significantly reduced systemic levels of C-reactive protein (P<0.05). CONCLUSIONS The results suggest that oral/topical RvE1 attenuates enhanced atherogenesis induced by periodontitis and prevents vascular inflammation and atherogenesis in the absence of periodontitis. The inhibition of vascular inflammation with endogenous mediators of resolution of inflammation provides a novel approach in the prevention of atherogenic events.
Collapse
Affiliation(s)
- Hatice Hasturk
- From the Department of Applied Oral Sciences, Center for Periodontology, The Forsyth Institute, Cambridge, MA (H.H., A.K., D.N., T.E.V.D.); Department of Biological and Diagnostic Sciences, Beirut Arab University, Beirut, Lebanon (R.A.); Department of Biophysics, Boston University School of Medicine, MA (J.H.); and Department of Biomedical Engineering, Boston University, MA (N.G.).
| | - Rima Abdallah
- From the Department of Applied Oral Sciences, Center for Periodontology, The Forsyth Institute, Cambridge, MA (H.H., A.K., D.N., T.E.V.D.); Department of Biological and Diagnostic Sciences, Beirut Arab University, Beirut, Lebanon (R.A.); Department of Biophysics, Boston University School of Medicine, MA (J.H.); and Department of Biomedical Engineering, Boston University, MA (N.G.)
| | - Alpdogan Kantarci
- From the Department of Applied Oral Sciences, Center for Periodontology, The Forsyth Institute, Cambridge, MA (H.H., A.K., D.N., T.E.V.D.); Department of Biological and Diagnostic Sciences, Beirut Arab University, Beirut, Lebanon (R.A.); Department of Biophysics, Boston University School of Medicine, MA (J.H.); and Department of Biomedical Engineering, Boston University, MA (N.G.)
| | - Daniel Nguyen
- From the Department of Applied Oral Sciences, Center for Periodontology, The Forsyth Institute, Cambridge, MA (H.H., A.K., D.N., T.E.V.D.); Department of Biological and Diagnostic Sciences, Beirut Arab University, Beirut, Lebanon (R.A.); Department of Biophysics, Boston University School of Medicine, MA (J.H.); and Department of Biomedical Engineering, Boston University, MA (N.G.)
| | - Nicholas Giordano
- From the Department of Applied Oral Sciences, Center for Periodontology, The Forsyth Institute, Cambridge, MA (H.H., A.K., D.N., T.E.V.D.); Department of Biological and Diagnostic Sciences, Beirut Arab University, Beirut, Lebanon (R.A.); Department of Biophysics, Boston University School of Medicine, MA (J.H.); and Department of Biomedical Engineering, Boston University, MA (N.G.)
| | - James Hamilton
- From the Department of Applied Oral Sciences, Center for Periodontology, The Forsyth Institute, Cambridge, MA (H.H., A.K., D.N., T.E.V.D.); Department of Biological and Diagnostic Sciences, Beirut Arab University, Beirut, Lebanon (R.A.); Department of Biophysics, Boston University School of Medicine, MA (J.H.); and Department of Biomedical Engineering, Boston University, MA (N.G.)
| | - Thomas E Van Dyke
- From the Department of Applied Oral Sciences, Center for Periodontology, The Forsyth Institute, Cambridge, MA (H.H., A.K., D.N., T.E.V.D.); Department of Biological and Diagnostic Sciences, Beirut Arab University, Beirut, Lebanon (R.A.); Department of Biophysics, Boston University School of Medicine, MA (J.H.); and Department of Biomedical Engineering, Boston University, MA (N.G.).
| |
Collapse
|
12
|
Nikus K, Järvinen O, Sclarovsky S, Huhtala H, Tarkka M, Eskola M. Electrocardiographic Presentation of Left Main Disease in Patients Undergoing Urgent or Emergent Coronary Artery Bypass Grafting. Postgrad Med 2015; 123:42-8. [DOI: 10.3810/pgm.2011.03.2262] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
13
|
LVH and the diagnosis of STEMI - how should we apply the current guidelines? J Electrocardiol 2014; 47:655-60. [DOI: 10.1016/j.jelectrocard.2014.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Indexed: 11/24/2022]
|
14
|
The long-term prognostic value of the ST depression criteria for ischemia recommended in the universal definition of myocardial infarction in 43,661 veterans. Int J Cardiol 2014; 173:494-8. [DOI: 10.1016/j.ijcard.2014.03.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 03/11/2014] [Accepted: 03/14/2014] [Indexed: 11/18/2022]
|
15
|
Birnbaum Y, Wilson JM, Fiol M, de Luna AB, Eskola M, Nikus K. ECG diagnosis and classification of acute coronary syndromes. Ann Noninvasive Electrocardiol 2013; 19:4-14. [PMID: 24382164 DOI: 10.1111/anec.12130] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In acute coronary syndromes, the electrocardiogram (ECG) provides important information about the presence, extent, and severity of myocardial ischemia. At times, the changes are typical and clear. In other instances, changes are subtle and might be recognized only when ECG recording is repeated after changes in the severity of symptoms. ECG interpretation is an essential part of the initial evaluation of patients with symptoms suspected to be related to myocardial ischemia, along with focused history and physical examination. Patients with ST-segment elevation on their electrocardiogram and symptoms compatible with acute myocardial ischemia/infarction should be referred for emergent reperfusion therapy. However, it should be emphasized that a large number of patients may have ST-elevation without having acute ST-elevation acute coronary syndrome, while acute ongoing transmural ischemia due to an abrupt occlusion of an epicardial coronary artery may occur in patients with ST-elevation less than the thresholds defined by the guidelines. Up-sloping ST-segment depression with positive T waves is increasingly recognized as a sign of regional subendocardial ischemia associated with severe obstruction of the left anterior descending coronary artery. Widespread ST-segment depression, often associated with inverted T waves and ST-segment elevation in lead aVR during episodes of chest pain, may represent diffuse subendocardial ischemia caused by severe coronary artery disease. In case of hemodynamic compromise, urgent coronary angiography has been increasingly recommended for these patients.
Collapse
Affiliation(s)
- Yochai Birnbaum
- The Section of Cardiology, Baylor College of Medicine, Houston, TX; Texas Heart Institute, Saint Luke's Episcopal Hospital, Houston, TX
| | | | | | | | | | | |
Collapse
|
16
|
Tan NS, Goodman SG, Yan RT, Elbarouni B, Budaj A, Fox KA, Gore JM, Brieger D, López-Sendón J, Langer A, van de Werf F, Steg PG, Yan AT. Comparative prognostic value of T-wave inversion and ST-segment depression on the admission electrocardiogram in non-ST-segment elevation acute coronary syndromes. Am Heart J 2013; 166:290-7. [PMID: 23895812 DOI: 10.1016/j.ahj.2013.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/17/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND ST-segment depression (STD) is predictive of adverse outcomes in non-ST-segment elevation acute coronary syndromes (NSTE-ACS), but there are conflicting data on the incremental prognostic value of T-wave inversions (TWIs) on the admission electrocardiogram. METHODS Admission electrocardiograms of 7,343 patients with NSTE-ACS from the Global Registry of Acute Coronary Events (GRACE) and ACS I registry were independently analyzed at a core laboratory and stratified by TWI and STD status. We performed multivariable analyses to determine the independent prognostic significance of TWI and tested for interaction between TWI and STD for adverse outcomes. RESULTS Patients with TWI and/or STD had a higher prevalence of cardiovascular risk factors, higher Killip class, and higher GRACE risk scores. Among the 2,708 patients with available angiographic data, rates of 3-vessel or left main disease were similar between patients with TWI and those without TWI/STD. After adjusting for other established prognosticators, TWI did not independently predict in-hospital (adjusted odds ratio 1.03, 95% CI 0.75-1.42, P = .85) or 6-month mortality (adjusted odds ratio 1.02, 95% CI 0.80-1.30, P = .88); STD remained a strong independent predictor. There was no interaction between TWI and STD for these outcomes. No contiguous lead groups or cumulative number of leads with TWI provided independent prognostic information. CONCLUSIONS TWI is associated with other high-risk clinical features but is not an independent predictor of adverse short- and long-term mortality in NSTE-ACS. T-wave inversion does not provide additional prognostication beyond the GRACE risk model, and its concomitant presence does not alter the prognostic value of STD.
Collapse
|
17
|
Bakhoya VN, Kurl S, Laukkanen JA. T-wave inversion on electrocardiogram is related to the risk of acute coronary syndrome in the general population. Eur J Prev Cardiol 2012; 21:500-6. [PMID: 22952285 DOI: 10.1177/2047487312460022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND T-wave inversion (TWI) is a frequently encountered electrocardiographic (ECG) finding during routine medical examination of asymptomatic individuals, and of patients with various clinical conditions. However, the role of isolated TWI in the prediction of acute coronary syndrome (ACS) in the community has not been extensively studied. We investigated the relationship between TWI in routine ECG and the risk for ACS in the general population. METHODS This study is based on a random sample of 1997 men aged 42-60 years in Eastern Finland. Electrocardiograms recorded at rest were classified using the Minnesota codes. The association between isolated TWI and ACS was determined using a multivariable adjusted Cox proportional hazard model. RESULTS Negative T-waves were present in 3.6% of the participants. During an average follow-up of 20 years, a total of 493 ACS events were registered. After adjusting for age, TWI was associated with a 3.10-fold (95% confidence interval (CI) 2.21-4.32) risk for ACS. After additional adjustment for previously known coronary risk factors, TWI remained statistically significant in predicting ACS (relative risk 2.23; 95% CI 1.57-3.15). Negative T-waves was one of the strongest risk markers for ACS compared with other ECG-based variables such as left ventricular hypertrophy, previous Q-wave and prolonged QRS duration. CONCLUSION TWI has a strong and independent predictive value for ACS in the general population.
Collapse
Affiliation(s)
- Victor N Bakhoya
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Finland
| | | | | |
Collapse
|
18
|
Nikus KC, Sclarovsky S, Huhtala H, Niemelä K, Karhunen P, Eskola MJ. Electrocardiographic presentation of global ischemia in acute coronary syndrome predicts poor outcome. Ann Med 2012; 44:494-502. [PMID: 21679105 DOI: 10.3109/07853890.2011.585345] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Global ischemia (GI) electrocardiogram (ECG), wide-spread ST depression with inverted T waves maximally in leads V(4-5), and lead aVR ST elevation (STE), is a marker of an adverse outcome in patients with non-ST elevation acute coronary syndromes (ACS), perhaps because this pattern is indicative of left main stenosis. The prognostic value of this ECG pattern has not been established. AIMS The distribution of ECG changes and the prognostic value of the GI ECG were studied. METHODS ECGs of consecutive patients admitted with suspected ACS (n = 1,188) were classified into seven ECG categories: STE, Q waves without STE, left bundle branch block, left ventricular hypertrophy, GI ECG, other ST depression and/or T wave inversion, and other findings. RESULTS The GI ECG pattern predicted a high rate (48%) of composite end-points (mortality, re-infarction, unstable angina, resuscitation, or stroke) at 10-month follow-up compared to the other ECG categories (36%) (HR 1.78; CI 95% 1.31-2.41; P < 0.001). In multivariate analysis, the GI ECG pattern was associated with a higher rate of composite end-points (HR 1.40; CI 95% 1.02-1.91; P = 0.035). The multivariate analysis furthermore identified age, creatinine level, and diabetes as independent predictors of prognosis. CONCLUSIONS The GI ECG pattern predicted an unfavorable outcome, when compared to other ECG patterns in patients with ACS.
Collapse
Affiliation(s)
- Kjell C Nikus
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | | | | | | | | | | |
Collapse
|
19
|
Anttila I, Nikus K, Kähönen M, Jula A, Reunanen A, Salomaa V, Nieminen MS, Lehtimäki T, Virtanen V, Verrier RL, Varis J, Sclarovsky S, Nieminen T. Prognostic implications of quantitative ST-segment characteristics and T-wave amplitude for cardiovascular mortality in a general population from the Health 2000 Survey. Ann Med 2010; 42:502-11. [PMID: 20854212 DOI: 10.3109/07853890.2010.505932] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS We determined the gender-specific prognostic importance of quantitative measures of the ST segment and T wave in a community cohort. METHODS Data were collected from 5613 Finnish individuals. Four electrocardiogram (ECG) lead groups were used: anterior, lateral, inferior, and lead V5. ST-segment depression, determined at four points along the ST segment, and T-wave amplitude were treated as continuous variables in Cox regression analyses. RESULTS During a median follow-up period of 72.4 months, 120 cardiovascular deaths were registered. Among women, lateral lead group as well as lead V5 showed highly significant adjusted hazard ratios at all four ST-depression assessment points. This significance was lost in women ≥ 55 years when those with ECG-based criteria of left ventricular hypertrophy (LVH) were excluded. Results for ST-segment depression were not significant among men. As those with LVH were excluded, men ≥ 55 years showed borderline significance. T-wave amplitude did not reach significance among men, while lateral leads and lead V5 bore prognostic information among women. CONCLUSION Quantitative ST-segment depression, regardless of the measurement point, allows prediction of cardiovascular death in women within a general population. However, the effect disappears as those with LVH are excluded. This observation highlights the need for consideration of LVH when depressed ST segments are clinically observed.
Collapse
Affiliation(s)
- Ismo Anttila
- Division of Internal Medicine, Department of Cardiology, Seinäjoki Central Hospital, Finland
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Nikus K, Pahlm O, Wagner G, Birnbaum Y, Cinca J, Clemmensen P, Eskola M, Fiol M, Goldwasser D, Gorgels A, Sclarovsky S, Stern S, Wellens H, Zareba W, de Luna AB. Electrocardiographic classification of acute coronary syndromes: a review by a committee of the International Society for Holter and Non-Invasive Electrocardiology. J Electrocardiol 2010; 43:91-103. [DOI: 10.1016/j.jelectrocard.2009.07.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Indexed: 10/20/2022]
|
21
|
Kosuge M, Kimura K. Clinical Implications of Electrocardiograms for Patients With Non-ST-Segment Elevation Acute Coronary Syndromes in the Interventional Era. Circ J 2009; 73:798-805. [DOI: 10.1253/circj.cj-08-1147] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| |
Collapse
|
22
|
Kosuge M, Ebina T, Hibi K, Morita S, Komura N, Hashiba K, Kiyokuni M, Nakayama N, Umemura S, Kimura K. Early, Accurate, Non-Invasive Predictors of Left Main or 3-Vessel Disease in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome. Circ J 2009; 73:1105-10. [DOI: 10.1253/circj.cj-08-1009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masami Kosuge
- The Division of Cardiology, Yokohama City University Medical Center
| | - Toshiaki Ebina
- The Division of Cardiology, Yokohama City University Medical Center
| | - Kiyoshi Hibi
- The Division of Cardiology, Yokohama City University Medical Center
| | - Satoshi Morita
- The Division of Cardiology, Yokohama City University Medical Center
| | - Naohiro Komura
- The Division of Cardiology, Yokohama City University Medical Center
| | | | | | - Naoki Nakayama
- The Division of Cardiology, Yokohama City University Medical Center
| | - Satoshi Umemura
- The Division of Cardiology, Yokohama City University Medical Center
| | - Kazuo Kimura
- The Division of Cardiology, Yokohama City University Medical Center
| |
Collapse
|