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Reduction of QTD--A Novel Marker of Successful Reperfusion in NSTEMI. Pathophysiologic Insights by CMR.

Jensen CJ, Lusebrink S, Wolf A, Schlosser T, Nassenstein K, Naber CK, Sabin GV, Bruder O - Int J Med Sci (2015)

Bottom Line: No marker on ECG is established to predict successful reperfusion in NSTEMI.QT dispersion is increased by myocardial ischemia and reduced by successful restoration of epicardial blood flow by PCI.Thus, QTd-Rrel can indicate successful reperfusion therapy.

View Article: PubMed Central - PubMed

Affiliation: 1. Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth Hospital Essen, Germany;

ABSTRACT

Background/objectives: Non-ST segment elevation myocardial infarction (MI) poses similar detrimental long-term prognosis as ST-segment elevation MI. No marker on ECG is established to predict successful reperfusion in NSTEMI. QT dispersion is increased by myocardial ischemia and reduced by successful restoration of epicardial blood flow by PCI. Whether QT dispersion reduction translates to smaller infarcts and thus indicates successful reperfusion is unknown. We hypothesized that the relative reduction of QT dispersion (QTD-Rrel ) on a standard ECG in acutely reperfused NSTEMI is related to infarct size and infarct transmurality as assessed by delayed enhancement CMR (DE-CMR).

Methods and results: 69 patients with a first acute NSTEMI were included. QTD-Rrel was stratified according to LV function and volumes, infarct transmurality and size as assessed by DE-CMR. Extensive myocardial infarction was defined as above median infarct size. LV function and end-systolic volume were only mildly related to QTD-Rrel . QTD-Rrel was inversely related to infarct size (r=-0.506,p=0.001) and infarct transmurality (r=-0.415, p=0.001). QTD-Rrel was associated with extensive myocardial infarction in univariate analysis (odds ratio (OR) 0.958, CI 0.935-0.982; p=0.001). Compared to clinical and angiographic data QTD-Rrel remained the only independent predictor of non-transmural infarcts (OR 1.110, CI 1.055-1.167; p=0.049).

Conclusion: In patients with acute Non-ST-Segment Myocardial infarction QTd-Rrel calculated on a surface ECG prior and post PCI for restoration of epicardial blood flow detects small, non-transmural infarcts as assessed by delayed enhancement CMR. Thus, QTd-Rrel can indicate successful reperfusion therapy.

No MeSH data available.


Related in: MedlinePlus

A) CMR scan of an 63-year-old male exhibiting only a minor reduction of QTd-Rrel post revascularization (QTd-Rrel 1st tertile). This patient had extensive, predominantly transmural myocardial infarction (average infarct transmurality: 95%, QTd-Rrel :0%) with presence of microvascular obstruction. B) A typical CMR scan of a patient with high reduction QTd-Rrel . This 60-year-old male was categorized to the 3rd tertile of QTd-Rrel . CMR images showed limited, non-transmural infarction (average infarct transmurality: 22%, QTd-Rrel: 80%).
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Figure 3: A) CMR scan of an 63-year-old male exhibiting only a minor reduction of QTd-Rrel post revascularization (QTd-Rrel 1st tertile). This patient had extensive, predominantly transmural myocardial infarction (average infarct transmurality: 95%, QTd-Rrel :0%) with presence of microvascular obstruction. B) A typical CMR scan of a patient with high reduction QTd-Rrel . This 60-year-old male was categorized to the 3rd tertile of QTd-Rrel . CMR images showed limited, non-transmural infarction (average infarct transmurality: 22%, QTd-Rrel: 80%).

Mentions: The presence and extent of microvascular obstruction on DE-CMR was significantly correlated to QTd-Rrel (r=-0.725, p<0.001 and r=-0.719, p<0.001), respectively. Patients in the 1st tertile of QTd-Rrel had the highest prevalence (69%) and extent of microvascular obstruction (4.1% of LV mass), and patients in the third tertile of QTd-Rrel showed the lowest (0%). A typical CMR scan of patients with low and high QTd-Rrel post revascularization is shown in figure 3a and 3b.


Reduction of QTD--A Novel Marker of Successful Reperfusion in NSTEMI. Pathophysiologic Insights by CMR.

Jensen CJ, Lusebrink S, Wolf A, Schlosser T, Nassenstein K, Naber CK, Sabin GV, Bruder O - Int J Med Sci (2015)

A) CMR scan of an 63-year-old male exhibiting only a minor reduction of QTd-Rrel post revascularization (QTd-Rrel 1st tertile). This patient had extensive, predominantly transmural myocardial infarction (average infarct transmurality: 95%, QTd-Rrel :0%) with presence of microvascular obstruction. B) A typical CMR scan of a patient with high reduction QTd-Rrel . This 60-year-old male was categorized to the 3rd tertile of QTd-Rrel . CMR images showed limited, non-transmural infarction (average infarct transmurality: 22%, QTd-Rrel: 80%).
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4441062&req=5

Figure 3: A) CMR scan of an 63-year-old male exhibiting only a minor reduction of QTd-Rrel post revascularization (QTd-Rrel 1st tertile). This patient had extensive, predominantly transmural myocardial infarction (average infarct transmurality: 95%, QTd-Rrel :0%) with presence of microvascular obstruction. B) A typical CMR scan of a patient with high reduction QTd-Rrel . This 60-year-old male was categorized to the 3rd tertile of QTd-Rrel . CMR images showed limited, non-transmural infarction (average infarct transmurality: 22%, QTd-Rrel: 80%).
Mentions: The presence and extent of microvascular obstruction on DE-CMR was significantly correlated to QTd-Rrel (r=-0.725, p<0.001 and r=-0.719, p<0.001), respectively. Patients in the 1st tertile of QTd-Rrel had the highest prevalence (69%) and extent of microvascular obstruction (4.1% of LV mass), and patients in the third tertile of QTd-Rrel showed the lowest (0%). A typical CMR scan of patients with low and high QTd-Rrel post revascularization is shown in figure 3a and 3b.

Bottom Line: No marker on ECG is established to predict successful reperfusion in NSTEMI.QT dispersion is increased by myocardial ischemia and reduced by successful restoration of epicardial blood flow by PCI.Thus, QTd-Rrel can indicate successful reperfusion therapy.

View Article: PubMed Central - PubMed

Affiliation: 1. Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth Hospital Essen, Germany;

ABSTRACT

Background/objectives: Non-ST segment elevation myocardial infarction (MI) poses similar detrimental long-term prognosis as ST-segment elevation MI. No marker on ECG is established to predict successful reperfusion in NSTEMI. QT dispersion is increased by myocardial ischemia and reduced by successful restoration of epicardial blood flow by PCI. Whether QT dispersion reduction translates to smaller infarcts and thus indicates successful reperfusion is unknown. We hypothesized that the relative reduction of QT dispersion (QTD-Rrel ) on a standard ECG in acutely reperfused NSTEMI is related to infarct size and infarct transmurality as assessed by delayed enhancement CMR (DE-CMR).

Methods and results: 69 patients with a first acute NSTEMI were included. QTD-Rrel was stratified according to LV function and volumes, infarct transmurality and size as assessed by DE-CMR. Extensive myocardial infarction was defined as above median infarct size. LV function and end-systolic volume were only mildly related to QTD-Rrel . QTD-Rrel was inversely related to infarct size (r=-0.506,p=0.001) and infarct transmurality (r=-0.415, p=0.001). QTD-Rrel was associated with extensive myocardial infarction in univariate analysis (odds ratio (OR) 0.958, CI 0.935-0.982; p=0.001). Compared to clinical and angiographic data QTD-Rrel remained the only independent predictor of non-transmural infarcts (OR 1.110, CI 1.055-1.167; p=0.049).

Conclusion: In patients with acute Non-ST-Segment Myocardial infarction QTd-Rrel calculated on a surface ECG prior and post PCI for restoration of epicardial blood flow detects small, non-transmural infarcts as assessed by delayed enhancement CMR. Thus, QTd-Rrel can indicate successful reperfusion therapy.

No MeSH data available.


Related in: MedlinePlus