Prognostic value of initial QRS analysis in anterior STEMI: Correlation with left ventricular systolic dysfunction, serum biomarkers, and cardiac outcomes

López‐Castillo, Marta; Aceña, Álvaro; Pello-Lázaro, Ana María; Viegas, Vanessa; Muñoz, B. Merchan; Carda, Rocío; Franco‐Peláez, Juan Antonio; Martín-Mariscal, María Luisa; Figuero, S Briongos; Tuñón, José

doi:10.1111/anec.12791

Cited by 7 publications

(4 citation statements)

References 24 publications

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“…Thus, in our study, a pathological Q wave was more often registered in patients with lEF (almost twice more often than in patients with mEF), which is consistent with some other studies that also demonstrated the association of this ECG sign with reduced EF below 40% [ 45 , 46 ]. The presence of a pathological Q wave in ECG often points to existing myocardial fibrosis.…”

Section: Discussionsupporting

confidence: 92%

Electrocardiographic Patterns of Depolarization Abnormalities Help to Identify Reduced Left Ventricular Ejection Fraction

et al. 2022

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The aim of the study was to investigate the relationship between a decrease in the left ventricular ejection fraction (EF) and traditional ECG signs associated with structural changes of the myocardium (pathological Q wave, ventricular arrhythmias) and relatively new and poorly understood (fragmented QRS complex (fQRS), early repolarization pattern (ERP)) and evaluate their significance for identifying patients with mildly reduced EF (mrEF). The study included 148 patients who were treated and examined at the Almazov Medical Research Center. FQRS, ERP, pathological Q wave, and premature ventricular contractions (PVC) were described in the analysis of the ECG, and the results of echocardiography and statistical data were analyzed: Fisher’s test and chi-square, correlation analysis, and ROC analysis. According to the level of EF, patients were divided into three groups: group 1—patients with low EF (lEF) (less than 40%), group 2—patients with mildly reduced EF (mrEF) (40–49%); group 3—patients with preserved EF (pEF) (more than 50%). In the first group (EF), fQRS was registered in 16 (51.6%) patients, in the mrEF in 16 (18.2%). Pathological Q wave was detected in lEF in 20 (65%), in mrEF in 10 (35%), 15 (18%), in pEF in 15 (18%). The fQRS has been found to be more important in identifying patients with mrEF. In lEF in 2 (6.5%) patients, in mrEF in 2 (6.9%), in pEF in 11 (12.5%). There was no relationship between ERP, the amount of PVC, and the presence of ventricular tachycardia with EF. FQRS is significantly more common occurred with a decrease in EF and may be a marker of a mrEF. Thus, fQRS is associated with mrEF and pay close attention in routine clinical practice to identify patients at high risk of developing systolic dysfunction.

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Section: Discussionsupporting

confidence: 92%

Electrocardiographic Patterns of Depolarization Abnormalities Help to Identify Reduced Left Ventricular Ejection Fraction

et al. 2022

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“…The presence of pathological Q-waves on the admission ECG is predictive of increased mortality, heart failure and cardiogenic shock after STEMI [3,4,72]. According to Lopez-Castillo et al, the sum of Q-wave depth at discharge performs better than the number of leads with pathological Q-waves as an independent predictor of LVSD development [73].…”

Section: Pathological Q-wavesmentioning

confidence: 99%

Assessment of Selected Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction

Fabiszak

Kasprzak

Koziński

et al. 2021

JCM

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Objective: To assess the performance of ten electrocardiographic (ECG) parameters regarding the prediction of left ventricular systolic dysfunction (LVSD) after a first ST-segment-elevation myocardial infarction (STEMI). Methods: We analyzed 249 patients (74.7% males) treated with primary percutaneous coronary intervention (PCI) included into a single-center cohort study. We sought associations between baseline and post-PCI ECG parameters and the presence of LVSD (defined as left ventricular ejection fraction [LVEF] ≤ 40% on echocardiography) 6 months after STEMI. Results: Patients presenting with LVSD (n = 52) had significantly higher values of heart rate, number of leads with ST-segment elevation and pathological Q-waves, as well as total and maximal ST-segment elevation at baseline and directly after PCI compared with patients without LVSD. They also showed a significantly higher prevalence of anterior STEMI and considerably wider QRS complex after PCI, while QRS duration measurement at baseline showed no significant difference. Additionally, patients presenting with LVSD after 6 months showed markedly more severe ischemia on admission, as assessed with the Sclarovsky-Birnbaum ischemia score, smaller reciprocal ST-segment depression at baseline and less profound ST-segment resolution post PCI. In multivariate regression analysis adjusted for demographic, clinical, biochemical and angiographic variables, anterior location of STEMI (OR 17.78; 95% CI 6.45–48.96; p < 0.001), post-PCI QRS duration (OR 1.56; 95% CI 1.22–2.00; p < 0.001) expressed per increments of 10 ms and impaired post-PCI flow in the infarct-related artery (IRA; TIMI 3 vs. <3; OR 0.14; 95% CI 0.04–0.46; p = 0.001) were identified as independent predictors of LVSD (Nagelkerke’s pseudo R2 for the logistic regression model = 0.462). Similarly, in multiple regression analysis, anterior location of STEMI, wider post-PCI QRS, higher baseline number of pathological Q-waves and a higher baseline Sclarovsky-Birnbaum ischemia score, together with impaired post-PCI flow in the IRA, higher values of body mass index and glucose concentration on admission were independently associated with lower values of LVEF at 6 months (corrected R2 = 0.448; p < 0.00001). Conclusions: According to our study, baseline and post-PCI ECG parameters are of modest value for the prediction of LVSD occurrence 6 months after a first STEMI.

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“…The QRS complex morphology, and ST-segment changes, have already been described as potential predictors of certain outcomes. Some of the previous work analyzed the role of poor R wave progression, with a dominant QS pattern in V3, in reduced left ventricular ejection fraction (LVEF) prediction, as well as the influence of QRS complex width on left ventricular systolic dysfunction (LVSD) development, increased risk of heart failure (HF), and death [11,12]. Some of the more recent important ECG parameters are fragmented QRS (fQRS) and QRS distortion, which showed themselves useful in determining reperfusion success, and stratifying high cardiac risk patients [8].…”

Section: Introductionmentioning

confidence: 99%

The Role of QRS Complex and ST-Segment in Major Adverse Cardiovascular Events Prediction: A 6-Year Follow-Up Study

Maletin,

Petrovic,

Stojšić-Milosavljević

et al. 2024

Preprint

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Background: As a relatively high number of ST-segment elevation myocardial infarction (STEMI) patients develop major adverse cardiovascular events (MACE) following percutaneous coronary intervention (PCI), our aim was to determine the significance, and possible predictive value of QRS complex width and ST-segment elevation. Methods: Our patient sample included 200 PCI-treated STEMI patients, which were divided into two groups, based on the duration of symptoms: (I) less than 6 hours, and (II) 6-12 hours. For every patient, ECG was performed at 6 different time points. Long-term follow-up lasted 6 years from the STEMI onset. Statistical analysis was performed. Results: The mean age was 60.6±11.39 years, and 142 were male. Wider QRS complex, more pronounced ST-segment elevation, and more frequently absent ST-segment resolution were more common in the second group. Presentation of MACE was more frequent in this group. An increase of pre-PCI QRS complex width by 1 msec increases the risk of 6-year MACE by 3%, and an increase in pre-PCI ST-segment elevation by 1mm increases the risk of 6-year MACE by 3.26 times. Conclusion: To the best of our understanding, this study represents a pioneer research that utilized these ECG elements in the context of predicting a 6-year MACE. A wider QRS complex and a more pronounced ST-segment elevation were associated with longer total ischemic time. More research is needed to confirm these findings.

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Prognostic value of initial QRS analysis in anterior STEMI: Correlation with left ventricular systolic dysfunction, serum biomarkers, and cardiac outcomes

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 7 publications

References 24 publications

Electrocardiographic Patterns of Depolarization Abnormalities Help to Identify Reduced Left Ventricular Ejection Fraction

Electrocardiographic Patterns of Depolarization Abnormalities Help to Identify Reduced Left Ventricular Ejection Fraction

Assessment of Selected Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction

The Role of QRS Complex and ST-Segment in Major Adverse Cardiovascular Events Prediction: A 6-Year Follow-Up Study

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