ABSTRACT
Introduction: The presence of a Q-wave on a 12-lead electrocardiogram (ECG) has been considered a marker of a large myocardial infarction (MI). However, the correlation between the presence of Q-waves and nonviable myocardium is still controversial. The aims of this study were to 1) test QWA, a novel ECG approach, to predict transmural extent and scar volume using a 3.0 Tesla scanner, and 2) assess the accuracy of QWA and transmural extent. Methods: Consecutive patients with a history of coronary artery disease who came for myocardial viability assessment by CMR were retrospectively enrolled. Q-wave measurements parameters including duration and maximal amplitude were performed from each surface lead. A 3.0 Tesla CMR was performed to assess LGE and viability. Results: Total of 248 patients were enrolled in the study (with presence (n ¼ 76) and absence of pathologic Q-wave (n ¼ 172)). Overall prevalence of pathologic Q-waves was 27.2% (for LAD infarction patients), 20.0 % (for LCX infarction patients), and 16.8% (for RCA infarction patients). Q-wave area demonstrated high performance for predicting the presence of a nonviable segment in LAD territory (AUC 0.85, 0.77e0.92) and a lower, but still significant performance in LCX (0.63, 0.51e0.74) and RCA territory (0.66, 0.55e0.77). Q-wave area greater than 6 ms mV demonstrated high performance in predicting the presence of myocardium scar larger than 10% (AUC 0.82, 0.76e0.89). Conclusion: Q-wave area, a novel Q-wave parameter, can predict non-viable myocardial territories and the presence of a significant myocardial scar extension.
ABSTRACT
Background@#In many low- to middle-income countries in Asia, patients with NVAF usually received warfarin for thromboembolic prevention due to cost-effectiveness. The SAMe-TT2R2 score has been proposed to predict TTR in NVAF patients. However, the SAMe-TT2R2 score has not been much validated in Asian population. Interestingly, it may overestimate patients who had TTR < 65% due to regarding being Asians as a risk factor. @*Objectives@#To determine the factors predicting poor anticoagulant control on warfarin, create new scoring system, and compare with the SAMe-TT2R2 score in a Thai population with NVAF. @*Methods@#This is a retrospective study in a tertiary care hospital. We enrolled NVAF patients who received warfarin from January 2014 to December 2018. TTR was calculated based on Rosendaal method. Multiple logistic regression and AUC-ROC curve were used for analysis. @*Results@#A total of 864 patients were enrolled with mean age of 73.6 ± 11.58 years. The mean TTR was 48.1 ± 25.2%. Using multivariate regression analysis, the predictive factors for TTR < 65% were antiplatelet use (OR 4.49, p ≤ 0.001), LVEF < 40% (OR 1.92, p = 0.037), chronic kidney disease (GFR < 50 ml/min/1.73 m2 ) (OR 1.68, p = 0.013), history of CHF (OR 1.7, p = 0.047), and age ≥ 75 years (OR 1.4, p = 0.037). Based on the regression coefficients, we developed the new scoring system called ACAChE score [A, antiplatelet use (4 points); C, chronic kidney disease, GFR < 50 ml/min/1.73 m2 (2 points); A, age ≥ 75 years (1 point); Ch, history of CHF (2 points); E, LVEF < 40% (2 points)]. ROC curve showed discrimination performance of the ACAChE score and SAMe-TT2R2 score for prediction of TTR < 65% with the C-statistic of 0.62 (95%CI 0.57–0.65) and 0.54 (95%CI 0.50–0.58), respectively. @*Conclusion@#In Thai NVAF patients, the ACAChE score (antiplatelet use, chronic kidney disease (GFR < 50 ml/ min/1.73 m2 ), age ≥ 75 years, history of congestive heart failure, and LVEF < 40%) has better prediction for TTR < 65% than SAMe-TT2R2 score. Thus, it expected to guide the selection of oral anticoagulation in Asian patients with NVAF.
ABSTRACT
Background@#In many low- to middle-income countries in Asia, patients with NVAF usually received warfarin for thromboembolic prevention due to cost-effectiveness. The SAMe-TT2R2 score has been proposed to predict TTR in NVAF patients. However, the SAMe-TT2R2 score has not been much validated in Asian population. Interestingly, it may overestimate patients who had TTR < 65% due to regarding being Asians as a risk factor. @*Objectives@#To determine the factors predicting poor anticoagulant control on warfarin, create new scoring system, and compare with the SAMe-TT2R2 score in a Thai population with NVAF. @*Methods@#This is a retrospective study in a tertiary care hospital. We enrolled NVAF patients who received warfarin from January 2014 to December 2018. TTR was calculated based on Rosendaal method. Multiple logistic regression and AUC-ROC curve were used for analysis. @*Results@#A total of 864 patients were enrolled with mean age of 73.6 ± 11.58 years. The mean TTR was 48.1 ± 25.2%. Using multivariate regression analysis, the predictive factors for TTR < 65% were antiplatelet use (OR 4.49, p ≤ 0.001), LVEF < 40% (OR 1.92, p = 0.037), chronic kidney disease (GFR < 50 ml/min/1.73 m2 ) (OR 1.68, p = 0.013), history of CHF (OR 1.7, p = 0.047), and age ≥ 75 years (OR 1.4, p = 0.037). Based on the regression coefficients, we developed the new scoring system called ACAChE score [A, antiplatelet use (4 points); C, chronic kidney disease, GFR < 50 ml/min/1.73 m2 (2 points); A, age ≥ 75 years (1 point); Ch, history of CHF (2 points); E, LVEF < 40% (2 points)]. ROC curve showed discrimination performance of the ACAChE score and SAMe-TT2R2 score for prediction of TTR < 65% with the C-statistic of 0.62 (95%CI 0.57–0.65) and 0.54 (95%CI 0.50–0.58), respectively. @*Conclusion@#In Thai NVAF patients, the ACAChE score (antiplatelet use, chronic kidney disease (GFR < 50 ml/ min/1.73 m2 ), age ≥ 75 years, history of congestive heart failure, and LVEF < 40%) has better prediction for TTR < 65% than SAMe-TT2R2 score. Thus, it expected to guide the selection of oral anticoagulation in Asian patients with NVAF.