A 12-lead ECG-method for quantifying ischemia-induced QRS prolongation to estimate the severity of the acute myocardial event

Elmberg, Viktor; Almer, Jakob; Pahlm, Olle; Wagner, Galen S.; Engblom, Henrik; Ringborn, Michael

doi:10.1016/j.jelectrocard.2016.02.001

Cited by 12 publications

(10 citation statements)

References 16 publications

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“…All IQP measurements were made according to a single 12 lead ECG method (Elmberg et al, 2016). The computer-generated QRS duration was noted for each ECG.…”

Section: Ecg Analysismentioning

confidence: 99%

Ischemic QRS prolongation as a biomarker of myocardial injury in STEMI patients

Almer

Elmberg

Bränsvik

et al. 2018

Noninvasive Electrocardiol

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Background Patients with acute coronary occlusion (ACO) may not only have ischemia‐related ST‐segment changes but also changes in the QRS complex. It has recently been shown in dogs that a greater ischemic QRS prolongation (IQP) during ACO is related to lower collateral flow. This suggests that greater IQP could indicate more severe ischemia and thereby more rapid infarct development. Therefore, the purpose was to evaluate the relationship between IQP and measures of myocardial injury in patients presenting with acute ST‐elevation myocardial infarction (STEMI). Methods Seventy‐seven patients with first‐time STEMI were retrospectively included from the recently published SOCCER trial. All patients underwent a cardiac magnetic resonance (CMR) examination 2–6 days after the acute event. Infarct size (IS), myocardium at risk (MaR), and myocardial salvage index (MSI) were assessed and related to IQP. IQP measures assessed were; computer‐generated QRS duration, QRS duration at maximum ST deviation, absolute IQP and relative IQP, all derived from a pre‐PCI, 12‐lead ECG. Results Median absolute IQP was 10 ms (range 0–115 ms). There were no statistically significant correlations between measures of IQP and any of the CMR measures of myocardial injury (absolute IQP vs IS, r = 0.03, p = 0.80; MaR, r = −0.01, p = 0.89; MSI, r = −0.05, p = 0.68). Conclusions Unlike previous experimental studies, the IQP was limited in patients presenting at the emergency room with first‐time STEMI and no correlation was found between IQP and CMR variables of myocardial injury in these patients. Therefore, IQP does not seem to be a suitable biomarker for triaging patients in this clinical context.

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“…All IQP measurements were made according to a single 12 lead ECG method (Elmberg et al, 2016). The computer-generated QRS duration was noted for each ECG.…”

Section: Ecg Analysismentioning

confidence: 99%

Ischemic QRS prolongation as a biomarker of myocardial injury in STEMI patients

Almer

Elmberg

Bränsvik

et al. 2018

Noninvasive Electrocardiol

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“…In another manuscript, included in the current issue of the journal, Elmberg et al report on a novel method for measuring QRS prolongation during ischemia [11], which is a modification of the method published by Almer et al, published in an earlier issue of the journal [2]. While Almer et al compared the QRS duration during ischemia to the baseline QRS duration (before ischemia), using a single ECG lead [2], Elmberg compared QRS duration in different leads during the same time point [11], as in the clinical setting the "baseline" ECG before ischemia is usually not available in patients presenting with STEMI.…”

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confidence: 99%

“…While Almer et al compared the QRS duration during ischemia to the baseline QRS duration (before ischemia), using a single ECG lead [2], Elmberg compared QRS duration in different leads during the same time point [11], as in the clinical setting the "baseline" ECG before ischemia is usually not available in patients presenting with STEMI. Their method is probably based on the paradigm that the surface ECG leads record local events and that there could be differences in the QRS duration among the different leads.…”

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confidence: 99%

“…The method of Almer et al uses several assumptions that should be substantiated by future studies. In QRS complexes that show no distinct J-point, they defined the QRS offset as the point where a superimposed line descending from the peak of the R-wave along 40% of the amplitude (between the peak of the R-wave to the nadir of the ST segment) intersects with the PR segment [2,11]. Usually, the TP segment is used for the isoelectric line, although with tachycardia and ECGs with prominent U-waves it might be difficult to determine the isoelectric line.…”

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confidence: 99%

“…The Sclarovsky-Birnbaum score does not rely on absolute measurement of the QRS duration, as it was felt that the baseline duration of the QRS in patients with coronary artery disease and related diseases (hypertension, hypertrophy, etc.) varies and frequently, accurate measurement of the QRS duration is difficult and time consuming, as pointed out in the papers of Demidova and Elmberg [1,11]. Further studies by independent groups have shown that grade III of ischemia is associated with increased mortality, larger final infarct size and less myocardial salvage with reperfusion therapy.…”

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confidence: 99%

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