Obvious ST-segment Research Articles

Indices of left ventricular voltage on electrocardiogram are closely associated with serum cardiac troponin I levels in normotensive Japanese individuals.

The high-sensitivity cardiac troponin I (hs-cTnI) in serum can increase due to an increase in left ventricular (LV) overload in individuals with hypertension. Since LV voltage on an electrocardiogram (ECG) reflects LV load, it is possible that LV voltage is closely associated with hs-cTnI in individuals without hypertension. This study investigated the association between LV voltage indices and serum hs-cTnI levels in normotensive Japanese individuals.Subjects who visited the Enshu Hospital for a health check-up were screened for their eligibility. Subjects with renal dysfunction, cancer, active inflammatory disease, or a history of cardiovascular events were excluded, as were subjects with obvious ST segment or T wave abnormality, Wolff-Parkinson-White syndrome, pacemaker implantation, or frequent arrhythmia in the ECG. Exclusion of individuals with hypertension left 803 subjects (54.8 ± 11.3 years) for final inclusion. The R wave voltage in lead V5 (RV5 voltage), the Sokolow-Lyon voltage (a sum of the QRS wave (a complex wave consists of Q, R, and S wave) of the S wave voltage in lead V1 and the R wave voltage in lead V5), and the Cornell product (a product of QRS duration and QRS voltage) were evaluated by ECG as LV voltage indices. Laboratory measurements included serum hs-cTnI levels. Possible associations between indices of LV voltage on ECG and serum hs-cTnI levels were cross-sectionally investigated in the normotensive subjects.The median values [interquartile range] of hs-cTnI and BNP were and 2.1 [1.4-3.0] and 13.8 [7.7-24.9] pg/mL, respectively. Multivariate regression analysis identified that the levels of hs-cTnI, but not BNP, were significantly associated with RV5 voltage (β 0.090, P = .0087), Sokolow-Lyon voltage (β 0.112, P = .0009), and Cornell product (β 0.101, P = .039) after adjustment for possible confounding factors. Moreover, the RV5 voltage, Sokolow-Lyon voltage, and Cornell product were significantly associated with the hs-cTnI levels after adjustment for possible confounding factors including ECG findings (β 0.109, P = .0075; β 0.125, P = .0010; and β 0.096, P = .0116, respectively).Indices of LV voltage in ECG had close associations with serum hs-cTnI levels in normotensive subjects. These findings support that the ECG findings of LV voltage have significant associations with slight myocardial micro-damage even in normotensive subjects.

Serum metabolic profile involving protective effect of "Neiguan"(PC6)-electroacupuncture preconditioning in rats with myocardial ischemia reperfusion injury

To observe the effect of "Neiguan" (PC6)-electroacupuncture (EA) preconditioning on serum metabolites in myocardial ischemia-reperfusion injury (MIRI) rats, so as to reveal its mechanism underlying improvement of ischemic myocardium from metabonomics. A total of 48 male SD rats were randomly divided into control, model, EA "Neiguan"(PC6) and EA "Hegu"(LI4) groups (n＝12 rats/ group). Rats of the control group were just banded on animal boards for 30 min, once daily for 7 days. The MIRI model was established by occlusion of the left anterior descending branch of the left coronary artery for 40 min, followed by reperfusion for 1 h, and rats of the model group were also banded as those in the control group. Before modeling, EA (10 Hz/50 Hz, 1 mA) was applied to bilateral "Neiguan"(PC6) and "Hegu"(LI4) for 30 min, once daily for 7 successive days. After the treatment, serum samples were collected to be analyzed by proton nuclear magnetic resonance (1H NMR) spectroscopy. The orthogonal partial least squares discriminate analysis (PLS-DA) was employed to distinguish the serum differential metabolic profile of rats in different groups and identify potential biomarkers. After modeling, the ECG of model group and electroacupuncture groups showed T wave towering, and there was no obvious ST segment between R wave and T wave. The T wave decreased more than 0.2 mV after reperfusion, and there was no obvious ST segment. Compared with the control group, MIRI induced significant changes of metabolites in the serum including increase of acetoacetate acid, lectic acid, creatine, glycerol and glucose, and decrease of alanine, glutamine, glycerophosphoryl choline and phosphorylcholine. In comparison with the model group, PC6-EA preconditioning induced significant changes, including an increase of glucose, and a decrease of leucine，isoleucine, valine，3-hydroxybutyric acid，lactate，acetate，acetone，acetoacetate acid，pyruvic acid，glutamine，creatine and glycerol. There is no significant difference in metabolic patterns between "Hegu" group and model group. Metabolic pathway enrichment analysis indicated that the protective effect of PC6-EA pretreatment was realized mainly by regulating pathways of glycolysis, gluconeogenesis, citric acid metabolism, pyruvate metabolism, ketone body metabolism, etc. PC6-EA pretreatment has a role in regulating gluconeogenesis, pyruvate metabolism, amino metabolism, ketone body metabolism and energy metabolism in rats with MIRI, which maybe contribute to its protective effect on ischemic myocardium, but the specific metabolic pathways and mechanisms need being studied further.

The de winter electrocardiogram pattern is a transient electrocardiographic phenomenon that presents at the early stage of ST-segment elevation myocardial infarction.

The de Winter electrocardiogram (EKG) pattern is a novel sign that indicates left anterior descending coronary artery (LAD) occlusion in patients with chest pain. This study aimed to assess the prevalence and clinical characteristics of patients with this pattern. The de Winter EKG pattern is an special anterior ST-segment elevation myocardial infarction (STEMI) equivalents without obvious ST-segment elevation. This retrospective study included all patients with anterior myocardial infarction admitted between January 2011 and December 2017. Patients were categorized into two groups: those with the de Winter EKG pattern and those with typical STEMI. Of 441 patients, 15 (3.4%) with anterior myocardial infarction had the de Winter EKG pattern. Similar to those with typical STEMI, the majority of patients with the de Winter EKG pattern had ST-segment elevation, pathologic Q wave, and absence of R wave at follow-up. The median time from recognition of this pattern until its evolution was 114 minutes. The ST-segment in leads V3R to V5R and leads V7 to V9 were normal or slightly depressed when a typical de Winter EKG pattern was noted in leads V1 to V6. The culprit lesion was mainly in the proximal LAD or the diagonal branch. Patients with this EKG pattern responded poorly to thrombolytic therapy. We believe that the de Winter EKG pattern may be a sign of ischemia and presents at the early stage of STEMI rather than being an independent pattern. In patients with this pattern, a percutaneous coronary intervention rather than follow-up and thrombolytic strategy should be performed.

Development and prospective validation of an ischemic risk score for acute chest pain patients with normal high-sensitivity troponin I levels and without obvious ST-segment deviation

Objective: To develop and prospectively validate a risk score for acute chest pain patients with normal high-sensitivity troponin I (hs-TnI) levels and without obvious ST-segment deviation in China. Methods: Chest pain patients admitted to the emergency department of Beijing Anzhen Hospital from September 2014 to July 2015 were enrolled. Baseline characteristics of patients met inclusion criteria including normal hs-TnI levels and without obvious ST-segment deviation were included. The endpoint (major adverse cardiovascular events) was a composite of acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, and all-cause death within 3 months after initial presentation. Predictors were screened and used to develop the risk score model by logistic regression analysis in a retrospective cohort. Then, the risk score model was evaluated in a prospective validation cohort. Results: The study population of derivation cohort included 1 735 consecutive chest pain patients. Finally, 1 030 eligible patients were enrolled. Multivariate regression analysis defined five independent predictors: male gender (β=0.88); history of chest pain (β value of moderate and high suspicion of coronary heart artery was 2.70 and 3.51 respectively); electrocardiogram (β=0.84); ≥60 years old (β=0.51) and ≥3 risk factors (β=0.85).The range of weighted score was set as 0-13. The area under a receiver operating characteristic (ROC) curve was 0.75 (95%CI 0.72-0.78) in the final model. Major adverse cardiovascular events rates increased in proportion to score increase (P<0.01). The internal validity used bootstrap technique showed the same predictor factors as the final model, and its area under a ROC curve was 0.75(95%CI 0.72-0.78).MACE rates in the low risk group (score 0-3), intermediate risk group (score 4-7), and high risk group (score 8-13) were 1.3% (1/77) ,19.0% (22/116) ,and 42.2% (122/289) in the prospective validation cohort, respectively (P<0.01). Conclusion: The developed ischemic risk score is feasible for risk stratification of acute chest pain patients with normal hs-TnI and without obvious ST-segment deviation, this score might be helpful to the decision making of treatment and management strategies for these patients.

GW24-e0319 The clinical significance of the automatic warning function of cardiac remote monitoring systems in preventing acute cardiac episodes

ObjectivesIn addition to ambulatory Holter electrocardiographic recording and transtelephonic electrocardiographic monitoring (TTM), a cardiac remote monitoring system can provide an automatic warning function through the general packet radio service (GPRS)...

Profound myocardial ischemia associated to occlusion of the right coronary artery

A 75-year-old man with hypertension, hypercholesterolemia and history of coronary artery disease was admitted to the hospital because of sudden loss of consciousness. The patient suffered an acute myocardial infarction seven years before this admission, which was treated with percutaneous transluminal coronary angioplasty and stent implantation in the right coronary artery. The initial electrocardiogram showed a complete atrioventricular block, with narrow ventricular complexes at a rate of 40 bpm. The next electrocardiogram, obtained after the administration of atropine, showed a sinus rhythm at 84 bpm with first-degree atrioventricular block, obvious ST-segment elevation on leads II, III, aVF, V3 to V6, and electrical alternation of the ST-segment. Subsequently, he suffered three episodes of ventricular fibrillation which were successfully defibrillated. The ST-segment elevation improved after sublingual nitroglycerine and the patient underwent urgent coronary angiography, which showed a critical stenosis in the middle part of the right coronary artery with a lot of thrombus material in the site of the previous stent. The rest of the coronary arteries did not reveal significant lesions. Thrombus aspiration and balloon angioplasty were successfully performed without residual stenosis. The ST-elevation alternans is a rare phenomenon which was initially described in the setting of coronary artery spasm. It is believed to be associated to profound myocardial ischemia, particularly in relation with occlusions of the left anterior descending coronary artery, and to the occurrence of malignant ventricular arrhythmia and sudden cardiac death.

A case of transient left mid ventricular ballooning without obvious ST segment change on the electrocardiogram during acute phase

A case of transient left mid ventricular ballooning without obvious ST segment change on the electrocardiogram during acute phase

Diagnosis

Diagnosis

Clinical significance of automatic warning function of cardiac remote monitoring systems in preventing acute cardiac episodes.

Objective: In addition to ambulatory Holter electrocardiographic recording and transtelephonic electrocardiographic monitoring (TTM), a cardiac remote monitoring system can provide an automatic warning function through the general packet radio service (GPRS) network, enabling earlier diagnosis, treatment and improved outcome of cardiac diseases. The purpose of this study was to estimate its clinical significance in preventing acute cardiac episodes. Methods: Using 2 leads (V1 and V5 leads) and the automatic warning mode, 7160 patients were tested with a cardiac remote monitoring system from October 2004 to September 2007. If malignant arrhythmias or obvious ST-T changes appeared in the electrocardiogram records was automatically transferred to the monitoring center, the patient and his family members were informed, and the corresponding precautionary or therapeutic measures were implemented immediately. Results: In our study, 274 cases of malignant arrhythmia, including sinus standstill and ventricular tachycardia, and 43 cases of obvious ST-segment elevation were detected and treated. Because of early detection, there was no death or deformity. Conclusions: A cardiac remote monitoring system providing an automatic warning function can play an important role in preventing acute cardiac episodes.