Size and transmural extent of first-time reperfused myocardial infarction assessed by cardiac magnetic resonance can be estimated by 12-lead electrocardiogram

Engblom, Henrik; Hedström, Erik; Heiberg, Einar; Wagner, Galen S.; Pahlm, Olle; Arheden, Håkan

doi:10.1016/j.ahj.2005.07.022

Cited by 50 publications

(33 citation statements)

References 36 publications

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“…19-21 A good correlation between ceCMR and the Selvester QRS score estimation of infarct size has been reported in patients 1 week following reperfused AMI. 19 Although there is not a clinical study that has evaluated the relationship between QRS score on admission ECG and imaging modalities for estimating myocardial necrosis before reperfusion therapy in AMI patients, the QRS score on admission has been reported to provide important information for predicting myocardial salvage 13 and 30-day mortality 14 with reperfusion therapy. We adopted a modified QRS scoring system 9 as a measure of the extent of myocardial necrosis at presentation.…”

Section: Maruhashi T Et Almentioning

confidence: 99%

Effect of Prodromal Angina Pectoris on the Infarct Progression in Patients With First ST-Elevation Acute Myocardial Infarction

Maruhashi

Ishihara

Inoue

et al. 2010

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp he time elapsed from coronary occlusion to reperfusion is 1 of the most important factors that determine the extent of myocardial necrosis. 1,2 After coronary occlusion, myocardial necrosis first occurs in the subendocardial region but with increasing duration of the occlusion, irreversible injury progresses as a wavefront toward the subepicardium. 3,4 This infarct progression is modified by several factors, including the presence of functioning collateral coronary arteries to the area at risk, myocardial oxygen demands, and ischemic preconditioning. Episodes of transient ischemia protect the myocardium against subsequent prolonged ischemia. Prodromal angina pectoris (AP) has a cardioprotective effect by the mechanism of ischemic preconditioning. 5 Experimental studies have demonstrated that ischemic preconditioning delays the progression of myocardial infarction (MI). 6,7However, there are no clinical data on the effect of prodromal AP on progression of MI in humans, because of the difficulty in measuring the extent of myocardial necrosis before reperfusion. Development of Q wave and R-wave regression of the electrocardiogram (ECG) reflects the progression of the infarction process, and the QRS score has been used to estimate the size of myocardial necrosis. 8-12 QRS score at presentation is a measure of myocardial necrosis before reperfusion and predict myocardial salvage and major adverse cardiac events. 13,14 This study was undertaken to investigate the effect of prodromal AP on the relationship between time to reperfusion and myocardial necrosis assessed by QRS score before reperfusion in patients with ST-elevation acute MI (AMI). Background: Prodromal angina pectoris (AP) has a cardioprotective effect by the mechanism of ischemic preconditioning, and the QRS score on the admission electrocardiogram (ECG) reflects myocardial damage at presentation. This study was undertaken to investigate the effect of prodromal AP on infarct progression after the onset of acute myocardial infarction (AMI).

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Section: Maruhashi T Et Almentioning

confidence: 99%

Effect of Prodromal Angina Pectoris on the Infarct Progression in Patients With First ST-Elevation Acute Myocardial Infarction

Maruhashi

Ishihara

Inoue

et al. 2010

Circ J

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“…35 However, the Selvester QRS scoring system, used for MI quantification from the ECG in the present study, has been shown to be useful for estimating both size and transmurality of acute MI. 18 The QRS score is based not only on presence of Q waves, but also other infarct-related changes of the QRS complex such as loss of R-and S-wave amplitudes and durations as well as ratios between different waveforms.…”

Section: Engblom Et Al Time Course Of Infarct Involutionmentioning

confidence: 99%

“…The absolute and relative (to left ventricular mass) amounts of hyperenhanced myocardium and mean transmural extent of hyperenhancement were obtained as previously described. 18 In short, the transmural extent of hyperenhancement was determined using a centerline approach, assessing the radial extent of hyperenhancement at each 4.5°from the center of each short-axis slice. In addition, the endocardial extent of hyperenhancement was obtained by multiplying the circumferential endocardial extent of hyperenhancement in each short-axis slice by the thickness of each slice.…”

Section: Global Left Ventricular Function and Hyperenhancementmentioning

confidence: 99%

Rapid Initial Reduction of Hyperenhanced Myocardium After Reperfused First Myocardial Infarction Suggests Recovery of the Peri-Infarction Zone

Engblom

Hedström

Heiberg

et al. 2009

Circ: Cardiovascular Imaging

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114

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Background-The time course and magnitude of infarct involution, functional recovery, and normalization of infarctrelated electrocardiographic (ECG) changes after acute myocardial infarction (MI) are not completely known in humans. We sought to explore these processes early after MI and during infarct-healing using cardiac MRI. Methods and Results-Twenty-two patients with reperfused first-time MI were examined by MRI and ECG at 1,7, 42, 182, and 365 days after infarction. Global left ventricular function and regional wall thickening were assessed by cine MRI, and injured myocardium was depicted by delayed contrast-enhanced MRI. Infarct size by ECG was estimated by QRS scoring. The reduction of hyperenhanced myocardium occurred predominantly during the first week after infarction (64% of the 1-year reduction). Furthermore, during the first week the amount of nonhyperenhanced myocardium increased significantly (PϽ0.001), although the left ventricular mass remained unchanged. Left ventricular ejection fraction increased gradually, whereas the greater the regional transmural extent of hyperenhancement at day 1, the later the recovery of regional wall thickening. Regional wall thickening decreased progressively with increasing initial transmural extent of hyperenhancement (P trend Ͻ0.0001). The time course and magnitude of decrease in QRS score corresponded with the reduction of hyperenhanced myocardium. Conclusions-The early reduction of hyperenhanced myocardium may reflect recovery of hyperenhanced, reversibly injured myocardium, which must be considered when predicting functional recovery from delayed contrast-enhanced MRI findings early after infarction. Also, the time course and magnitude for reduction of hyperenhanced myocardium were associated with normalization of infarct-related ECG changes. (Circ Cardiovasc Imaging. 2009;2:47-55.)

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“…Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) is a well-validated tool for accurate and reproducible visualization of irreversible myocardial damage in the acute and chronic settings of MI (4). Several studies have shown that the presence of diagnostic Q waves is primarily determined by MI size rather than its transmural extent (5)(6)(7)(8)(9). The larger the endocardial extent of MI is, more likely it is that the ECG will be diagnostic for Q-wave MI (10).…”

mentioning

confidence: 98%

Electrocardiographic Q-Wave “Remodeling” in Reperfused ST-Segment Elevation Myocardial Infarction

Florian

Slavich

Masci

et al. 2012

JACC: Cardiovascular Imaging

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Size and transmural extent of first-time reperfused myocardial infarction assessed by cardiac magnetic resonance can be estimated by 12-lead electrocardiogram

Cited by 50 publications

References 36 publications

Effect of Prodromal Angina Pectoris on the Infarct Progression in Patients With First ST-Elevation Acute Myocardial Infarction

Effect of Prodromal Angina Pectoris on the Infarct Progression in Patients With First ST-Elevation Acute Myocardial Infarction

Rapid Initial Reduction of Hyperenhanced Myocardium After Reperfused First Myocardial Infarction Suggests Recovery of the Peri-Infarction Zone

Electrocardiographic Q-Wave “Remodeling” in Reperfused ST-Segment Elevation Myocardial Infarction

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