Early repolarization pattern on ECG predicts worse outcomes in patients hospitalized due to chronic heart failure decompensation.

BACKGROUND: To improve the outcomes of patients with chronic heart failure (CHF), it is important to identify reliable prognostic tools. Early repolarization pattern (ER) on 12­lead electrocardiogram (ECG) is a predictor of worse outcomes, which has been widely researched in the general population but not in the CHF population. OBJECTIVE: To evaluate the incidence and prognostic value of ER and compare its prognostic significance with other non-invasive diagnostic methods for CHF outcomes and hospital readmissions. METHODS: The study included 301 patients (166 men and 135 women) hospitalized for CHF decompensation. CHF diagnosis was confirmed according to the current guidelines. The patients underwent standard tests and impedance cardiography (ICG) at enrollment and on the day of discharge. RESULTS: Thirty-one confirmed ER cases (10.3%) were enrolled. During a median follow-up period of 18 months, 128 cardiac-related deaths were observed (42.5%), with 23 (74.2%) and 105 (38.9%) patients in the ER and non-ER groups, respectively (p < 0.001). The ER group had more readmissions than the non-ER group did at 6-months (2 [1, 2] vs. 1 [1, 2]; p=0.04) and 12-months (3 [2-4] vs. 2 [1-3]; p<0.001). ER on ECG (hazard ratio [HR] 2.59; 95% confidence interval [CI] 1.64-4.07; p<0.001), N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels ≥425.5 pmoL/L (HR 5.1; 95% CI 3.33-7.83; p < 0.001), thoracic fluid content (TFC) ≥36.9 1/kΩ (HR 4.6; 95% CI 2.7-7.85, p < 0.001), and left ventricular ejection fraction (LVEF) ≤40% (HR 4.94; 95% CI 2.83-8.65; p < 0.001) were independently and significantly associated with cardiac death. CONCLUSIONS: The combination of ER, LVEF ≤40%, NT-proBNP, or TFC provides an incremental prognostic value for cardiac-related death in patients with CHF.

Single-Center Study in Lithuania to Evaluate the Role of Transthoracic Impedance Cardiography in the Diagnosis and Outcome Evaluation of 301 Patients with Chronic Heart Failure Exacerbation.

BACKGROUND Scientific data regarding transthoracic impedance cardiography (ICG) parameters and its utility in patients with heart failure (HF) remains controversial. This study from a single center in Lithuania aimed to evaluate the role of ICG in the diagnosis and outcome evaluation of patients who were admitted to the hospital due to HF exacerbation. MATERIAL AND METHODS The sample consisted of 301 consecutive patients with a previous chronic HF diagnosis (166 men, 135 women) hospitalized for HF flare-ups. ICG data were compared to other noninvasive HF diagnostic tests. Data about patient outcomes were gathered from the Lithuanian Medical Record Database. RESULTS A weak correlation of amino-terminal pro-brain natriuretic peptide (NT-proBNP) with thoracic fluid content (TFC) and thoracic fluid content index (TFCI) was found (r=0.204, P<0.001 and r=0.207, P<0.001, respectively). There was weak to moderate correlation of 6-min walk distance with main ICG data. There was weak correlation between left ventricular ejection fraction (LVEF) with TFCI (r=-0.163, P=0.005), systolic index (r=-0.137, P=0.017), and systolic time ratio (r=0.236, P<0.001). By multivariate Cox proportional analysis, the following parameters were independently associated with cardiac death (P<0.001): NT-proBNP ≥425.5 pmoL/L (hazard ratio (HR), 5.104, 95% confidence interval (CI) 3.326-7.832), TFC ≥36.9 1/kOhm (HR, 4.604, 95% CI 2.701-7.849), LVEF ≤40% (HR, 4.942, 95% CI 2.8256-8.647). CONCLUSIONS The combination of non-invasively measured TFC, LVEF, and NT-proBNP showed great prognostic value for predicting readmissions and cardiac death in patients with HF.

Evaluation of the Reliability of Electrocardiographic Criteria for Cardiac Hypertrophy Based on Echocardiographic Data.

Background: Left ventricular hypertrophy (LVH) regardless of other risk factors may be associated with an increased risk of mortality from cardiovascular diseases. Therefore, timely diagnosis for LVH is important in order to avoid possible complications. One of the simplest and cheapest methods to diagnose LVH is electrocardiography (ECG). Although a number of ECG criteria for LVH is known, their reliability varies in many studies. Aim: To evaluate the reliability of ECG criteria for LVH based on transthoracic echocardiography (TTE) data. Methods: The study included all consecutive patients in Kaunas Clinical Hospital Department of Cardiology from December 2019 until March 2020 and from September until October 2020, after applying the inclusion and exclusion criteria. The sensitivity and specificity of the ECG criteria for LVH were assessed based on TTE measurements performed during the same inpatient setting. The reliability of the ECG criteria for LVH was assessed using ROC curves. Reliability differences in gender, age and nutritional status groups were assessed using ANOVA statistical method. Results: Data from 95 patients were analyzed (63.2% were women and 36.8% were men). The sensitivity, specificity and AUC of Sokolow-Lyon criterion were 9.38%, 85.71% and 0.44 (p = 0.034), R in aVL - 6.25%, 90.48% and 0.51 (p = 0.038), Cornell - 21.88%, 100 % and0.69 (p = 0.084), Cornell product - 31.25%, 95.24% and 0.72 (p = 0.070), Peguero-Lo Presti - 31.25%, 85.71% and 0.68 (p = 0.053), respectively. No statistically significant differences were observed among the individual gender, age and nutritional status groups. Conclusions: Sokolow-Lyon and RaVL criteria were not statistically significantly reliable in LVH diagnosis compared to TTE, unlike the Cornell, Cornell product, and Peguero-Lo Presti criteria.

Differences in the Selvester QRS score after primary PCI strategy and conservative treatment for STEMI patients with negative T waves.

BACKGROUND: According to current guidelines, the main indications for PCI in patients with STEMI are ST-segment deviations and defined time from the onset of symptoms. Negative T wave at admission can be a sign of prolonged ischemia or spontaneous reperfusion. In both situations, the urgent intervention is questionable. We evaluated the infarct size and in-hospital mortality in STEMI patients with negative T wave in cases of primary PCI strategy compared with conservative treatment. METHODS: A retrospective analysis of 116 STEMI patients with negative T wave at the presenting ECG was performed. Sixty-eight patients (59%) underwent primary PCI strategy (PCI group), and 48 (41%) were treated conservatively (non-PCI group). The infarct size estimated by using the Selvester score, and in-hospital mortality were evaluated. RESULTS: The difference between Selvester score values at admission and at discharge in the non-PCI group was statistically significant (1.48; 95% CI 0.694-2.27), while no significant difference was observed in the PCI group (-0.07; 95% CI -0.546-0.686). The in-hospital mortality was higher in the non-PCI group; however, the numbers were relatively small: PCI 2 (2.9%) and non-PCI 5 (10.4%). CONCLUSION: In this study, we showed a reduction in the infarct size estimated by Selvester score in STEMI patients with negative T wave who were treated conservatively, while there was no significant change in the infarct size after primary PCI strategy. The higher mortality in patients treated conservatively could be attributed to higher age and comorbidities in the non-PCI group. It seems that conservative treatment strategy might be an option in STEMI patients with negative T wave.

A Comparison of Electronic and Traditional Stethoscopes in the Heart Auscultation of Obese Patients.

Background and objectives: As the prevalence of obesity is increasing in a population, diagnostics becomes more problematic. Our aim was to compare the 3M Littmann 3200 Electronic Stethoscope and 3M Littman Cardiology III Mechanical Stethoscope in the auscultation of obese patients. Methods. A total of 30 patients with body mass index >30 kg/m² were auscultated by a cardiologist and a resident physician: 15 patients by one cardiologist and one resident and 15 patients by another cardiologist and resident using both stethoscopes. In total, 960 auscultation data points were verified by an echocardiogram. Sensitivity and specificity data were calculated. Results. Sensitivity for regurgitation with valves combined was higher when the electronic stethoscope was used by the cardiologist (60.0% vs. 40.9%, p = 0.0002) and the resident physician (62.1% vs. 51.5%, p = 0.016); this was also the same when stenoses were added (59.4% vs. 40.6%, p = 0.0002, and 60.9% vs. 50.7%, p = 0.016, respectively). For any lesion, there were no significant differences in specificity between the electronic and acoustic stethoscopes for the cardiologist (92.4% vs. 94.2%) and the resident physician (93.6% vs. 94.7%). The detailed analysis by valve showed one significant difference in regurgitation at the mitral valve for the cardiologist (80.0% vs. 56.0%, p = 0.031). No significant difference in specificity between the stethoscopes was found when all lesions, valves and both physicians were combined (93.0% vs. 94.4%, p = 0.30), but the electronic stethoscope had higher sensitivity than the acoustic (60.1% vs. 45.7%, p < 0.0001). The analysis when severity of the abnormality was considered confirmed these results. Conclusions. There is an indication of increased sensitivity using the electronic stethoscope. Specificity was high using the electronic and acoustic stethoscope.

A constant ST segment elevation in leads II, III, AVF: An electrocardiographic, echocardiographic, clinical, exercise test, laboratory and multi-slice computed tomography angiographic study.

A constant ST-elevation was more often described in precordial leads. We presented it in leads II, III, AVF in 16 consecutive patients seeking to establish a link between it and clinical, laboratory, echocardiography, exercise test, and multi-slice computed tomography angiography data. Main complaint of these obese middle-age men was angina pectoris (68.75%). They usually had hypertension, dyslipidemia, concentric left ventricular hypertrophy and non-pathological exercise test. Coronary stenosis >50% was only in one case (6.25%). Despite the typical pain and risk factors, the constant ST-elevation in leads II, III, AVF usually was not associated with coronary stenosis.

Characteristics and Outcomes of Patients with Acute Myocardial Infarction at Non-PCI Capable Hospitals in 2007 and in 2014.

BACKGROUND: There is little known about whether characteristics and outcomes of patients with acute myocardial infarction (AMI) have changed over the years in non-PCI capable hospitals in real-life. Our aim was to assess them between 2007 and 2014. METHODS: It was a retrospective cohort study. Characteristics and in-hospital mortality (standardized in cases of different characteristics between the groups by original simple method) were assessed for all patients with non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI) at two non-PCI capable hospitals: one in 2007 (n = 104) and another in 2014 (n = 58). RESULTS: In 2014, females were older than in 2007 (80.18 ± 7.54 versus 76.15 ± 8.77, p = 0.011), males were younger (71.61 ± 11.22 versus 79.20 ± 7.63, p = 0.019), less had renal failure (RF) (19% versus 34.6%, p < 0.0001) and reinfarction (13.8% versus 35.6%, p < 0.0001), and the proportion of males (31% versus 43.3%, p = 0.001) and the proportion of NSTEMI (60.3 versus 69.2, p < 0.0001) decreased. In cases of STEMI there were no differences in patient characteristics. STEMI (18.8% versus 21.7%) and standardized mortalities by gender, RF, and reinfarction NSTEMI (19.47%, 15.34%, and 17.5%, resp., versus 17.1%) showed no differences between 2007 and 2014. CONCLUSIONS: There were some differences in patient characteristics but not in mortality for AMI at non-PCI capable hospitals between 2007 and 2014.

Comparison of the improvement in myocardial perfusion and function in cases of rapid and slow electrocardiographic stage dynamics between patients with TIMI-3 flow after primary angioplasty for acute myocardial infarction.

BACKGROUND AND OBJECTIVE: Post-PCI TIMI flow grade 3 in infarct-related artery not always is associated with follow-up improvement in myocardial perfusion and function. We compared the improvement in myocardial perfusion and function in cases of rapid and slow electrocardiographic (ECG) stage dynamics between patients with TIMI-3 flow after primary angioplasty for acute myocardial infarction (MI). MATERIALS AND METHODS: Ten patients with post-PCI TIMI-3 flow were divided into group A (n=50, no rapid change of ECG stages) and group B (n=50, with a ≥2 ECG stages per 2 days change rate). RESULTS: There were no significant changes after 3 months in scintigraphic (ejection fraction 44.6±9.3% vs. 42.0±3.4%, P=0.4; perfusion deficit severity 3.0±0.7 vs. 2.3±0.8, P=0.1) and echocardiographic (dysfunction score 1.9±0.2 vs. 1.6±0.5, P=0.2) data in group A. Scintigraphic data improved (ejection fraction 34.6±3.9% vs. 52.0±7.3, P=0.03; perfusion deficit severity 2.8±0.6 vs. 1.5±0.8, P=0.03) and changes in echocardiographic data were of borderline significance (dysfunction score 1.8±0.2 vs. 1.4±0.4, P=0.06) in group B. CONCLUSIONS: There was not any change in myocardial perfusion and function in a case of slow change of ECG stages after reached post-PCI TIMI flow grade 3, while myocardial perfusion improved and function tended to improve in a case of the rate at least two ECG stages in 2 days after primary angioplasty for acute MI.

T-wave normalization during follow-up after early and late mechanical recanalization of infarct-related artery with and without stent implantation.

OBJECTIVE: The aim of this study was to evaluate T-wave normalization during the 6-month follow-up in the patients who underwent early or late mechanical recanalization of the infarct-related artery with and without stent implantation. MATERIAL AND METHODS: A total of 248 consecutive patients were divided into the following groups: early angioplasty (≤24 hours) without (n=114) or with stents (n=6) and late angioplasty (>24 hours) without (n=114) or with stents (n=14). The changes in T-wave recovery, QRS score, and echocardiographic left ventricular ejection fraction were compared between the groups. RESULTS: At 3 months, a greater percentage of patients in the group of early angioplasty with stents had again positive T wave than in the group of early angioplasty without stents (75% vs. 35%, P=0.05). After 6 months, all patients in the group of early angioplasty with stents had again positive T wave. A significant increase in left ventricular ejection fraction after 3 months was also observed only in the groups of early angioplasty, especially that with stents (30.0% [SD, 3.5%] vs. 38.4% [SD, 5.2%], P=0.008). However, there was no significant difference in the QRS score in this group comparing the data at discharge and after 3 months (5.4 [SD, 4.3] vs. 5.0 [SD, 1.9], P>0.05). CONCLUSIONS: The group of early angioplasty with stents showed the best recovery of T wave and left ventricular ejection fraction, but the QRS score did not change significantly from discharge to the 3-month follow-up, so the evolution of T wave corresponded to an improvement in ejection fraction at follow-up better than the evolution of QRS score.

Changes of electrocardiographic and echocardiographic data after early and late mechanical recanalization of infarct-related artery with and without stent implantation.

OBJECTIVE: To show differences in the changes of electrocardiographic and echocardiographic data after early and late mechanical recanalization of infarct related artery with and without stent implantation and to assess the value of QRS score in the follow-up period. MATERIAL AND METHODS: A total of 248 consecutive patients were divided into these groups: early angioplasty (24 hours) angioplasty without stents (n=114) or with stents (n=14). The changes in QRS score and echocardiographic left ventricular ejection fraction during the hospital and 3-month follow-up periods were compared between the groups. RESULTS: QRS score did not increase in a hospital in early or late angioplasty with stents groups, while in the groups without stents especially of early angioplasty increased (2.6+/-2.5 vs. 3.6+/-2.4, P=0.001). Left ventricular ejection fraction increased after 3 months only in early angioplasty groups especially with stents (30.0+/-3.5 vs. 38.4+/-5.2, P=0.008), but there were no significant differences between the QRS score at discharge and after 3 months (5.4+/-4.3 vs. 5.0+/-1.9). CONCLUSIONS: Myocardial injury did not increase in a hospital in the cases of early or late angioplasty with stents, while in the cases without stents increased. Left ventricular ejection fraction increased after 3 months only in the cases of early angioplasty especially with the stent implantation, but the QRS score showed no differences, so the QRS score may be not predictive of improvement in ejection fraction at follow-up.

Prediction of improvement in left ventricular function during a 1-year follow-up after acute myocardial infarction by the degree of acute resolution of electrocardiographic changes.

BACKGROUND AND PURPOSE: Reperfusion therapy results in better left ventricle (LV) function in cases of successful myocardial reperfusion; however, insufficient reperfusion or reocclusion of the infarct-related artery is associated with LV dysfunction. This study was proposed to determine whether the rate of ECG stage dynamics, after mechanical, thrombolytic, or spontaneous recanalization, is a predictor of improvement in LV function. METHODS: Twenty-seven consecutive patients, observed for 1 year, were divided into group A (11, change rate of > or =2 ECG stages per 2 days), group B (13, no rapid change), and cases with reocclusion (3). RESULTS: Clinical and radiographic signs of heart failure tended to decrease in group A but tended to increase in other cases. Echocardiographic dyssynergic score decreased, and LV ejection fraction increased only in group A: 4.3 +/- 1.2 vs 2.7 +/- 1.5, P = .04, and 42.0 +/- 4.8 vs 46.0 +/- 8.3, P = .049, respectively; in group B, the values were 3.4 +/- 2.4 vs 3.4 +/- 2.2 and 44.0 +/- 6.9 vs 43.8 +/- 9.3, respectively. CONCLUSIONS: Rapid ECG stage changes predict follow-up improvement in LV function.

Prediction of decrease in myocardial perfusion defect size and severity during a 3-month follow-up by the degree of acute resolution of electrocardiographic changes.

Myocardial perfusion in infarct-related artery (IRA) distribution improves progressively until a few months after successful reperfusion therapy. We assessed the rate of electrocardiographic (ECG) stage dynamics to predict perfusion improvement after mechanical, thrombolytic, or spontaneous recanalization of IRA. Thirteen patients were divided into group A (n = 8, with > or = 2 ECG stages per 2-day change rate) and group B (n = 5, no rapid change of ECG stages). There were no significant technetium Tc 99m sestamibi scintigraphic differences between the groups 3 days after recanalization; however, after 3 months, perfusion deficit size (2.8 +/- 1.8 vs 4.8 +/- 1.2, P < or = .03) and severity (1.8 +/- 0.9 vs 3.0 +/- 0, P < or = .03) were smaller in group A vs group B. The prediction sensitivity of the method was 87.5% for decrease in size and 100% for decrease in severity of perfusion defect; the specificity was 80% and 100%, respectively. A change rate of 2 or more ECG stages per 2 days predicts follow-up improvement of myocardial perfusion after IRA recanalization.

Implementation of the patient education about cardiovascular risk factors into a daily routine of the Cardiology Unit of the hospital.

BACKGROUND: Cardiovascular disease remains the leading cause of death in developed countries. Main modifiable cardiovascular risk factors are smoking, hypertension and dyslipidemia. We sought to introduce the patient education about these risk factors into a daily routine of the Cardiology Unit of the hospital. METHODS: In November 2003, 56 patients filled out the questionnaire at discharge from the Cardiology Unit. Collected data were discussed with the physicians of this unit. In December 2003, 64 patients of this unit once again were asked to fill out the questionnaire. RESULTS: In December, less patients were not informed by physicians about smoking risk (3.1% versus 18.2%, P = 0.03) and diet (0% versus 18%, P = 0.0001), more patients quitted smoking (75% versus 50%, P = 0.03), less patients claimed unaware of their blood pressure (6.25% versus 21.4%, P = 0.01), cholesterol level (3.1% versus 60.7%, P = 0.00001) and the necessity to correct them (0% versus 22.7%, P = 0.0001, and 0% versus 64.3%, P = 0.00001). CONCLUSIONS: Implementation of the patient education about cardiovascular risk factors by physicians into the daily routine of the Cardiology Unit was successful.

[Percutaneous revascularization of myocardium: extent, application and treatment strategy of acute coronary syndromes]. / Perkutanine miokardo revaskulizacija ligoniams, sergantiems uminiais koronariniais sindromais. Gydymo apimtys ir strategija.

UNLABELLED: The comparative value of different factors of reperfusion technique and strategy in restoring of myocardial function is underestimated. The aim of this study is to assess the value of reperfusion strategy for restoring of myocardial function in follow-up period. MATERIAL AND METHODS: From 1999 to 2001, 4260 patients with acute coronary syndromes were analyzed. Coronarography was performed for 2990 patients and percutaneous coronary interventions - for 1257 patients. QRS score was calculated; electrocardiogram and echocardiograms were done for 248 patients with acute myocardial infarction after reperfusion therapy by percutaneous transluminal coronary angioplasty (PTCA) (228 patients) and by stenting (20 patients). Urgent PTCA was used for 114 patients, urgent stenting for 14 patients, delayed PTCA for 114 patients and delayed stenting for 6 patients. RESULTS: Coronarography was performed for 66% of all hospitalized patients; percutaneous coronary interventions - for 825 (45.6%) of patients with acute myocardial infarction and only for 11.7% of patients with unstable angina pectoris. In hospital period QRS score increased for all patients with the exception of patients with delayed stenting (p from 0.05 to 0.001). LVEF had tendency to increase in all groups of patients during 3 months. CONCLUSIONS: Coronarography can be performed for 65-70% of hospitalized patients with acute coronary syndromes and percutaneous coronary interventions for 45% of patients with acute myocardial infarction. Differences in reperfusion strategy do not have manifest value on restoring of left ventricle function.

[Early results of primary percutaneous transluminal coronary angioplasty: evaluation of myocardial reperfusion]. / Pirmines perkutanines vainikiniu arteriju angioplastikos ankstyvieji rezultatai. Miokardo reperfuzijos ivertinimas.

UNLABELLED: The purpose of the study was to determine the prognostic value of simultaneous evaluation of angiographic (TIMI flow) and ECG (ST segment resolution) changes on hospital results in primary percutaneous transluminal coronary angioplasty patients. METHODS AND PATIENTS: The primary percutaneous transluminal coronary angioplasty was performed in 250 patients with the first acute myocardial infarction. All the patient were divided into four groups according the restored TIMI flow and the resolution of ST segment changes. Group A (44 pts) - TIMIor=50%, group C (99 pts) - TIMI>2, ST resolution <50%, and group D (94 pts) - TIMI>2, ST resolution >or=50%. RESULTS: The study has revealed that in hospital mortality was 15.9%, 6.1% and 1.1% in group A, group C and group D, respectively. The higher proportion of patients with not adequate sufficient myocardial perfusion (less complete ST segment resolution) had myocardial infarction in left anterior descending artery region. The higher proportion of patients with adequate myocardial perfusion had no atherosclerotic injury in coronary arteries except infarct related artery. CONCLUSION: The achieving of TIMI flow grade 3 and perfect resolution of ST segment elevation after primary percutaneous transluminal coronary angioplasty has beneficial effect on in - hospital mortality. The effective restoration of flow in infarct related artery not always accompanies full and rapid ST segment normalization suggesting the presence of incomplete myocardial perfusion.

[Impact of the effectiveness of myocardial reperfusion after thrombolytic and spontaneous recanalization of infarct related artery on myocardial recovery in the future]. / Miokardo reperfuzijos po trombolizines ir savaimines rekanalizacijos efektyvumo itaka poinfarktiniam miokardo normalejimui velesniu laikotarpiu.

OBJECTIVE: To assess the efficiency of myocardial reperfusion after thrombolytic and spontaneous recanalization of infarct related artery (IRA) by the serial 12 lead ECG data and its impact on subsequent myocardial recovery. MATERIAL AND METHODS: We examined 25 patients with a first Q wave myocardial infarction at hospital and after 1 and 3 years from discharge (13 treated with intravenous thrombolysis, 12 treated conservatively). Four patients treated using thrombolysis and 3 patients treated conservatively were excluded from the analysis due to reocclusion or another myocardial infarction and coronary bypass surgery. The efficiency of myocardial reperfusion was assessed by our original method, based on the intensity of changes in ECG stages. The myocardial recovery was analyzed by quantitative changes in clinical, radiographic, echocardiographic and ECG (the Selvester-Wagner QRS score) data. RESULTS: Clinical and radiographic signs of heart failure decreased in cases of sufficient myocardial reperfusion after thrombolytic and spontaneous recanalization, but increased--in cases of insufficient myocardial reperfusion. Echocardiographic dyssynergic score decreased after 3 years from discharge (79, 67 after 1 and 3 yrs/at discharge (%), respectively, p < 0.00005) in cases of thrombolysis with sufficient myocardial reperfusion but the tendency for increasing (113, 183 after 1 and 3 yrs/at discharge (%), respectively, p = 0.07) was shown in cases of insufficient myocardial reperfusion; although, the QRS score decreased in both subgroups of thrombolysis (89, 36 after 1 and 3 yrs/at discharge (%), respectively, p < 0.01,--with sufficient myocardial reperfusion; 73, 62 after 1 and 3 yrs/at discharge (%), respectively, p < 0.005,--with insufficient myocardial reperfusion). CONCLUSIONS: The QRS score normalization after myocardial infarction predicts myocardial functional recovery only in patients with sufficient myocardial reperfusion. Thrombolysis gives positive impact on subsequent myocardial functional recovery only in cases of sufficient myocardial reperfusion; spontaneous recanalization of IRA may give positive impact on myocardial functional recovery in cases of sufficient myocardial reperfusion. Our method of serial ECG interpretation provides the possibility to detect insufficient myocardial reperfusion after thrombolytic and spontaneous recanalization and then the additional mechanical methods of recanalization should be applied.

[Quantitative assessment of acute myocardial infarction size. Impact of early mechanical recanalization of infarct related artery]. / Uminio infarktinio miokardo pazeidimo kiekybine diagnostika. Skubaus mechaninio infarkto arterijos rekanalizavimo poveikis.

UNLABELLED: The aim of investigation: 1) to determine the diagnostic value of QRS score and LV echocardiography in assessment of the size of myocardial infarction in acute stage, 2) to establish the impact of infarct related artery recanalization on myocardial infarction size. METHODS AND MATERIAL: In order to investigate whether infarct size could be estimated by QRS scoring system soon after reperfusion we evaluated QRS score obtained serially before and twice after reperfusion, and the echocardiographic global EF in 57 patients with acute myocardial infarction who underwent successful mechanical recanalization of infarct related artery. Coronary flow in infarct related artery was evaluated by the Thrombolysis in Myocardial Infarction trial (TIMI) criteria. QRS scores were calculated according to the method of Wagner (37 criteria and 29 points). The electrocardiographic ejection fractions (EFECG) were calculated according to Roubin method, and the global echocardiographic ejection fractions (EFECHO) were calculated according to Simpson method. All patients were divided into 3 groups according to the quality of myocardial reperfusion expressed as intensity in change of electrocardiographic phases at the time of infarct related artery recanalization (1 gr.--the change of ECG phases > or = 2; 2 gr.--the change of ECG phases through 1; and 3 gr.--with no changes of ECG stages). All patients had an effective infarct-related artery recanalization expressed as 2 or 3 TIMI grade. RESULTS: A low and insignificant correlation was observed between EFECG and EFECHO for patients with anterior myocardial infarction (r = 0.35) and for patients with posterior myocardial infarction (r = 0.12). The EFECG had a tendency to be lower in patients with worse myocardial reperfusion (from 59.06 +/- 6.12 in 1 gr. to 50.93 +/- 10.87 in 3 gr). At this time the EFECHO was almost the same in all groups of patients. Additionally, the EFECHO was significantly lower than EFEKG in all groups of patients (p = 0.000017-0.001). The QRS score had general tendency to increase after infarct-related artery recanalization, however the most evident increase was obtained in 1 gr. of patients with rapid change of ECG stages. A significant correlation (r = 0.87 for patients with anterior myocardial infarction and r = 0.85 for patients with posterior myocardial infarction) was observed between QRS scores obtained after infarct related artery recanalization and that obtained after 10-12 days. In conclusion, QRS score and EFEKG better than EFECHO reflects the myocardial infarction size in acute stage. Increasing of the myocardial infarction size after infarct-related artery recanalization is connected with reperfusional injury more expressed in patients with more effective myocardial reperfusion.