Resolution Of ST-segment Depression Research Articles

COMPARISON OF MYOCARDIAL BLUSH GRADE IN STEMI PATIENTS WITH AND WITHOUT RESOLUTION ON RECIPROCAL ST SEGMENT DEPRESSION UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION

Background: Acute coronay syndrome is one of the problems in cardiovascular system. The revascularization recommended according to the ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation (STEMI) (2017) are Primary Percutaneous Coronary Intervention (Primary PCI). ST Segment Depression (STSD) in the tapping area in the opposite direction from the infacrtion area (non infarction area) of STEMI. Myocardial Blush Grade (MBG) to assess the effectiveness of myocardial reperfusion. This study aim to assess the differences of MBG with or without reciprocal STSD resolution in STEMI patients with <12 hour onset undergoing primary PCI strategy. Methods: This study is a cross sectional study, in which 67 STEMI patients with onset <12 hours who underwent primary PCI therapy strategies at H. Adam Malik General Hospital, Murni Teguh Memorial Hospital, and Grandmed Hospital starting October 2018. Results of Myocardial Blush Grade (MBG) after primary PCI and electrocardiography evaluation of STSD changes in reciprocal leads at the start from emergency department (before primary PCI) and 90 minutes after Primary PCI. Statistical analysis was perfomed to assess the difference between MBG with or without reciprocal STSD resolution in STEMI patients undergoing primary PCI. Results: From 67 patients, 35 patients had reciprocal STSD resolution with MBG 3, and 32 patients without reciprocal STSD resolution with MBG ≤2. From the basic criteria of this research subjects to MBG, there are significant difference in infarct location (p 0.001) and KILLIP classification (p<0.005). This study found significant difference between MBG and reciprocal STSD resolution (p<0.001). Conclusion: There is a significant difference between MBG with reciprocal STSD resolution compared without reciprocal STSD resolution after primary PCI.

Resolution of ST-Segment Depression In Reciprocal Leads As Predictor Mayor Adverse Cardiac Event For ST-Segment Elevation Myocardial Infarction With Fibrinolytic Therapy

Background: ST Elevation Myocardial Infarction (STEMI) may cause Major Cardiovascular Event (MACE). Revascularization needs to be done in all STEMI patients to restore coronary blood flow, hence saving myocardial perfusion. ST Segment Depression (STSD) in reciprocal ECG lead is associated with poor prognosis in STEMI patients receiving fibrinolytic therapy. The main purpose of this study is to evaluate MACE in STEMI patients receiving fibrinolytic therapy using resolution in STSD. Methods: This cohort prospective study with 60 subjects of STEMI patients which are evaluated for MACE (death, heart failure, and rehospitalization) within 30 days after myocardial infarction. Resolution in STSD is defined as resolution ≥ 50% STSD in reciprocal leads within 90 minutes after fibrinolytic therapy.Results: Bivariate analysis showed that Ejection fraction (EF) <40% with OR 8,32 (2,11-32,74), p=0,001; smoking with OR 4,17 (1,05-16,57), p=0,034; Anterior STEMI with OR 3,94 (1,11-13,90), p= 0,027; Creatinine > 1,97 mg/dl with OR 3,69 (1,18-11,55), p= 0,022; complete outpatient medication with OR 5,23 (1,61-17,01), p= 0,004; fragmented QRS with OR 5,23 (1,61-17,01), p= 0,001; resolution in STSD with OR 26,35 (5,16-134, 40), p=<0,001; resolution in ST Segment Elevation with OR 10,5 (2,97-37,24), p=<0,001; are proven to be determining factor for MACE within 30 days. Multivariate analysis showed that among those determining factors for MACE, resolution in STSD on reciprocal leads is evidently the most dominant factor for predicting MACE within 30 days in STEMI patients receiving fibrinolytic therapy [OR 11.47 (1.14-115.10), p=0.038].Conclusion: There is significant difference in MACE within 30 days after myocardial infarction (MI) between patients with and without resolution in STSD. The subjects without resolution in STSD showed higher MACE incidence. Resolution in STSD is evidently an independent predictor for MACE within 30 days after myocardial infarction in STEMI patients.Keywords: Resolution in STSD, MACE, STEMI, Fibrinolytic

ST-segment depression resolution predicts infarct size and reperfusion injury in ST-elevation myocardial infarction

ObjectiveST-elevation myocardial infarction (STEMI) is frequently associated with reciprocal ST-segment depression in contralateral ECG leads. However, the relationship of the resolution of ST-segment depression (STD-R) with myocardial damage is unknown...

Prognostic significance of reciprocal ST segment depression resolution in patients with acute ST elevation myocardial infarction

Prognostic significance of reciprocal ST segment depression resolution in patients with acute ST elevation myocardial infarction

Resolution of ST-segment depression: a new prognostic marker in ST-segment elevation myocardial infarction

To evaluate the prognostic impact of ST depression resolution among patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI in the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial. In this study, 4729 of 5745 patients had analysable ECGs demonstrating concomitant ST-segment depression. Resolution of summation operatorST elevation (STE-R) and summation operatorST depression (STD-R) on 30 min post-PCI ECGs was dichotomized into those with > or =50 vs. <50% ST-segment resolution. Overall, 1143 patients (24%) had STD-R<50%. These patients had higher risk characteristics including older age, female sex, diabetes, hypertension, prior CHF/MI, Killip class >I, triple vessel disease, and less frequent TIMI 3 flow in the culprit coronary vessel post-PCI. After multivariable adjustment and accounting for STE-R, STD-R<50% remained an independent predictor for 90 day death and the composite of death, cardiogenic shock, or CHF. When compared with patients with both STE-R and STD-R> or =50%, patients with both STE-R and STD-R<50% had the worst outcomes [hazard ratios (HR) 90 day death: 2.54; 95% confidence intervals (CI): 1.71-3.77; HR 90 day composite: 2.18; 95% CI: 1.63-2.91]. When ST depression is present in STEMI patients undergoing primary PCI, STD-R<50% provides independent prognostic value that is incremental to STE-R.

Delayed Preconditioning-Mimetic Actions of Nitroglycerin in Patients Undergoing Exercise Tolerance Tests

Nitroglycerin (NTG) induces delayed preconditioning (PC)-mimetic effects in animal models and in humans during coronary angioplasty. We tested the hypothesis that NTG mitigates ischemia and enhances functional capacity during an exercise tolerance test (ETT) in patients with coronary artery disease. Twenty-eight patients with stable angina and ischemia documented by a stress test were randomized in a double-masked, crossover design to receive a titrated intravenous infusion of NTG or normal saline over 4 hours. At 24 to 28 hours after study medication infusion, each patient underwent 2 ETTs separated by a 1-week washout period. Compared with control patients, pretreatment with NTG was associated with a dose-dependent increase in exercise duration averaging 40 seconds (412+/-19 versus 372+/-24 seconds, P=0.014) and an improvement in ECG manifestations of ischemia, as shown by a decrease in maximal ST-segment depression (1.84+/-0.14 versus 1.63+/-0.13 mm, P=0.011), sum of ST-segment depressions in 12 leads (7.64+/-1.01 versus 6.61+/-0.83 mm, P=0.027), and time to resolution of ST-segment depression (229+/-30 versus 207+/-28 s, P=0.018). These benefits occurred despite an increase in myocardial workload after NTG, as indicated by a higher peak rate-pressure product (24 492+/-1054 versus 22 536+/-1019 mm Hg/min, P=0.015). NTG produces a late PC-mimetic effect that mitigates the ECG manifestations of ischemia during exercise and improves exercise capacity. To our knowledge, this is the first study to demonstrate that NTG can alleviate exercise-induced ischemia 24 hours after its administration, long after the hemodynamic effects have subsided. The finding that nitrate-induced late PC ameliorates a common manifestation of coronary artery disease has potentially significant implications for the management of this disorder and for the design of clinical trials.

Impact of ST-segment depression resolution on mortality after successful mechanical reperfusion in patients with ST-segment elevation acute myocardial infarction

The aim of the present study was to evaluate the additional prognostic effect of ST-depression resolution in 610 patients who had ST-elevation myocardial infarction and underwent successful primary angioplasty (postprocedural Thrombolysis In Myocardial Infarction 3 flow and complete resolution of ST-segment elevation). Incomplete resolution of ST-segment depression (<70%) was observed in 50 patients (8.2%). These patients were older, had a higher Killip's class at presentation, had larger infarcts, and had an increased 1-year mortality (10% vs 2%, p = 0.0004). At multivariate analysis, incomplete resolution of ST-segment depression was an independent predictor of 1-year mortality (p = 0.028).

MULTIDISCIPLINARY PAIN ABSTRACTS: 2 . Anesthesia (2)

Thoracic epidural, stellate ganglion, and thoracic paravertebral blocks all relieve angina. This case report is based on a woman (65 years of age) who was to undergo a lung cancer resection with a history that included a partial pituitary macroadenomectomy, hypertension, acromegaly, and diabetes. She denied any history of coronary artery disease. The authors discuss intraoperative resolution of ST segment depression after a right thoracic paravertebral block.

The influence of the resolution of reciprocal ST segment changes on in‐hospital complications of acute myocardial infarction after percutaneous coronary angioplasty

We studied 120 patients (M:F 105:15, mean age 57.5 ± l0.l years) with acute myocardial infarction (MI) successfully treated with percutaneous coronary angioplasty (PTCA) to analyze the influence of the resolution of the ST segment elevation and depression after intervention to 1 month composite endpoints of reinfarction or reocclusion, development of congestive heart failure (CF) and death. Sum of preintervention and postintervention ST segment elevation and depression and the rate of resolution of these ST segment elevations and depressions were recorded for every patient. A total of 17 (14.2 %) composite endpoint events (events group) were recorded (7 reocclusion or recurrent MI, 9 CF, and 1 death). On univariate analysis, events group patients were older (53.3 ± 9.9 vs. 58.8 ± 9.1 years, P = 0.032), had lesser resolution of ST segment elevations (85 ± 24 % vs. 44 ± 55%, P = 0.017) and depression (72 ± 26% vs. 52 ± 30%, P = 0.009), had greater preintervention ST segment elevation (17.49 ± 12.95 mm vs. 28.38 ± 20.41 mm, P = 0.045), had lower ejection fraction (59.3 ± 10.2% vs. 43.6 ± 9.4%, P < 0.001), and had more frequent multivessel disease (71% vs. 47%, P = 0.048) compared to the nonevents group. Time from angina to reperfusion, residual stenosis, sex, infarct location and infarct-related vessel distribution were similar. On multivariate analysis (logistic regression with backward likelihood ratio) only older age (P = 0.0752), lesser rate of resolution of ST segment depression (P = 0.0262) and lower ejection fractions (P = 0.0014) were retained as predictors of the composite endpoints. Relative risk conferred by less than 50% resolution of ST segment depressions for composite endpoints were 3.78 (95% CI 1.63–8.73). We conclude that the lack of resolution of the sum of reciprocal ST segment depressions identifies a subgroup of acute MI patients with greater morbidity after primary PTCA. Cathet. Cardiovasc. Diagn. 45:240–245, 1998. © 1998 Wiley-Liss, Inc.

Comparative Prognostic Significance of Simultaneous Versus Independent Resolution of ST Segment Depression Relative to ST Segment Elevation During Acute Myocardial Infarction

Objectives. We sought to determine the prognostic significance of simultaneous versus independent resolution of ST segment depression that occurs concomitant with ST segment elevation during acute myocardial infarction (AMI).Background. ST segment depression in leads other than those showing ST segment elevation during AMI is a common phenomenon. Whether this indicates adverse outcomes remains controversial. We hypothesized that the timing of ST segment depression resolution relative to ST segment elevation resolution might differentiate between a high risk group and a low risk group of patients.Methods. Continuous 12-lead ST segment monitoring was performed after thrombolytic therapy for AMI in 413 patients, 261 of whom met technical criteria for analysis. Blinded analysis of ST segment depression resolution patterns was used to group patients as follows: 1) no ST segment depression at any time (control group); 2) ST segment depression resolving simultaneously with ST segment elevation (simultaneous group); and 3) ST segment depression persisting after ST segment elevation resolution (independent group). These patterns were correlated with the outcomes—recurrent angina, reinfarction, heart failure and death—using chi-square analysis and the Fisher exact test for categoric variables and the Wilcoxon rank-sum test for continuous variables.Results. The incidence of recurrent angina, reinfarction and heart failure was similar among the three groups. In-hospital mortality, however, was significantly higher in the independent group (13%) than either the simultaneous group (1%, p < 0.001) or the control group (0%, p = 0.002).Conclusions. Continuous analysis of ST segment resolution identifies, among patients with AMI with concomitantly occurring ST segment elevation and depression, a subgroup with increased in-hospital mortality. The pathogenic mechanism of increased mortality is not currently known.

Myocardial dysfunction in treated adult hypopituitarism: a possible explanation for increased cardiovascular mortality.

To assess cardiac structure and function in patients with treated hypopituitarism and to determine their relation to the degree of growth hormone deficiency and body composition pattern. 26 patients with treated hypopituitarism were studied by cross sectional and Doppler echocardiography and by exercise testing. The results were analysed and their relation to the degree of growth hormone deficiency and body composition determined. All tests were performed in the department of cardiology and the unit of metabolic medicine at a tertiary referral centre. Patients with hypopituitarism referred for endocrine assessment. Left ventricular mass, left ventricular diastolic function, and exercise capacity in patients with hypopituitarism and their relation to growth hormone deficiency. Mean (SD) serum concentration of insulin-like growth factor 1 (IGE-1), a measure of growth hormone deficiency, was 82.4 (45) micrograms/l. Lean body mass calculated by measuring total body potassium was 50 (9) kg. All patients had a normal left ventricular mass index and a normal left ventricular ejection fraction. Eight patients had abnormal left ventricular diastolic function. There was a significant correlation between IGF-1 and left ventricular mass (r = 0.45, p less than 0.02). Lean body mass was also significantly correlated with left ventricular mass (r = 0.78, p less than 0.0001) and left ventricular diastolic function (r = -0.63, p less than 0.01). The mean exercise duration was 8.6 (3.6) minutes. There was a significant correlation between serum IGF-1 and the rate-pressure product on exercise (r = 0.47, p less than 0.01). Seven patients had planar ST segment depression greater than 0.1 mV during exercise testing. In five of these patients there was rapid resolution of ST segment depression immediately after exercise. Two patients developed considerable ST segment depression, and subsequent coronary angiography showed normal coronary arteries. Exercise-induced ST segment depression was not related to the severity or duration of growth hormone deficiency or serum cholesterol concentration. This study suggests that left ventricular mass and the rate-pressure product are related to the degree of growth hormone deficiency, that left ventricular diastolic dysfunction is frequently seen in hypopituitarism, and that these patients may have ischaemic-like ST segment changes during exercise testing. These findings may explain the increased cardiovascular mortality in patients with hypopituitarism and may also have implications for growth hormone replacement therapy in adults.

Prevalence, time course and malignancy of ventricular arrhythmia during spontaneous ischemic ST-segment depression

Ventricular arrhythmias during transient myocardial ischemia were studied in 60 patients with spontaneous angina and ≥1 ischemic attack with ST-segment depression during 24-hour ambulatory electrocardiography. The patients were divided into 2 groups: group 1, 10 patients (17%) who developed ventricular arrhythmias during 26 of 92 (28%) ischemic attacks; and group 2, 50 patients who did not show this phenomenon. Daily ischemic attacks, total ischemic time and the proportion of symptomatic ischemic attacks were significantly greater (p < 0.01) in group 1 versus group 2. In group 1 patients, ischemic attacks were found to have twice the duration in the presence of arrhythmias than in their absence (20.4 ± 11.9 vs 9.1 ±8.4 minutes, p < 0.01); arrhythmias were more common during symptomatic than during silent ischemic attacks (39 vs 13%, p < 0.02). Arrhythmias occurred at the onset or peak of ST-segment depression (ischemia phase) in 6 cases (60%), during the resolution of ST-segment depression (recovery phase) in 2 cases (20%) and during both phases of ischemic attacks in the remaining 2 (20%). When compared to recovery phase arrhythmias, ischemia phase arrhythmias were characterized by a later onset time (173 ± 144 vs 58 ± 54 seconds, p < 0.01) and a longer duration (105 ±107 vs 41 ± 22 seconds, p < 0.01). During the ischemia phase, 16 of 353 ventricular premature complexes initiated ventricular tachycardia, while during the recovery phase only 1 of 161 ventricular premature complexes resulted in ventricular tachycardia (4.5 vs 0.6%, p < 0.02). Thus, ventricular arrhythmias may accompany spontaneous ischemic ST-segment depression, when the latter is recurrent, prolonged and symptomatic; arrhythmias are characterized by a greater frequency, duration and malignancy during the ischemia phase than during the recovery phase of ischemic attacks.