QRS distortion in pre-reperfusion electrocardiogram is a bedside predictor of large myocardium at risk and infarct size (a METOCARD-CNIC trial substudy)

详细信息    查看全文

• 作者：Maria Jose Valle-Caballero^a ; ¹ ; ² ; Rodrigo Ferná ; ndez-Jimé ; nez^b ; ^c ; ¹ ; ² ; Raquel Dí ; az-Munoz^d ; ² ; Alonso Mateos^b ; ^e ; ^f ; ² ; Marta Rodrí ; guez-Á ; lvarez^g ; ² ; José ; A. Iglesias-Vá ; zquez^h ; ² ; Carmen Saborido^g ; ² ; Carolina Navarro^e ; ² ; M. Luisa Dominguez^e ; ² ; Luisa Gorjó ; n^h ; ² ; José ; C. Fontoira^h ; ² ; Valentí ; n Fuster^b ; ⁱ ; ² ; Juan Carlos Garcí ; a-Rubira^a ; ² ; Borja Ibanez^b ; ^j ; ² ; ^{bibanez@cnic.es" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Myocardial infarction ; QRS distortion ; Magnetic resonance ; Infarct size ; Myocardium at risk ; Electrocardiogram
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 January 2016
• 年：2016
• 卷：202
• 期：Complete
• 页码：666-673
• 全文大小：1415 K

文摘

QRS distortion is an electrocardiographic (ECG) sign of severe ongoing ischemia in the setting of ST-segment elevation acute myocardial infarction (STEMI). We sought to evaluate the association between the degree of QRS distortion and myocardium at risk and final infarct size, measured by cardiac magnetic resonance (CMR).

Methods

A total of 174 patients with a first anterior STEMI reperfused by primary angioplasty were prospectively recruited. Pre-reperfusion ECG was used to divide the study population into three groups according to the absence of QRS distortion (D0) or its presence in a single lead (D1) or in 2 or more contiguous leads (D2 +). Myocardium at risk and infarct size were determined by CMR one week after STEMI. Multiple regression analysis was used to study the association of QRS distortion with myocardium at risk and infarct size, with adjustment for relevant clinical and ECG variables.

Results

101 patients (58%) were in group D0, 30 (17%) in group D1, and 43 (25%) in group D2 +. Compared with group D0, presence of QRS distortion (groups D2 + and D1) was associated with a significantly adjusted larger extent of myocardium at risk (group D2 +: absolute increase 10.4%, 95% CI 6.1–14.8%, p < 0.001; group D1: absolute increase 3.3%, 95% CI 1.3–7.9%, p = 0.157) and larger infarct size (group D2 +: absolute increase 10.1%, 95% CI 5.5–14.7%, p < 0.001; group D1: absolute increase 4.9%, 95% CI 0.08–9.8%, p = 0.046).

Conclusions

Distortion in the terminal portion of the QRS complex on pre-reperfusion ECG in two or more leads is independently associated with larger myocardium at risk and infarct size in the setting of primary angioplasty-reperfused anterior STEMI. QRS distortion in only one lead is independently associated with larger infarct size in this setting. Our findings suggest that QRS distortion analysis could be included in risk-stratification of patients presenting with anterior STEMI.