QRS-Fragmentation: Perspectives for Use in Clinical Practice

2021 ◽  
Vol 76 (3) ◽  
pp. 279-286
Author(s):  
Yuri N. Fedulaev ◽  
Irina V. Makarova ◽  
Tatiana V. Pinchuk ◽  
Grigoriy A. Chuvarayan
Keyword(s):  
Myocardial Infarction ◽  
Diagnostic Algorithm ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction ◽  
Increased Risk ◽  
Qrs Fragmentation ◽  
Artery Disease ◽  
Stable Cad

The current article provides a detail review of foreign publications, discussing the opportunities and the benefits of evaluation of the QRS-fragmentation (fQRS) a new electrocardiographic (ECG) parameter in patients with coronary artery disease (CAD). Diagnostic criteria for narrow and wide QRS-complexes are defined. Main results of the comparative and correlation analysis, evaluating fQRS and electrocardiographic (pathologic Q-waves), echocardiographic (left ventricular ejection fraction), angiographic settings are described. There is a discussion of the prognostic role of fQRS in stable CAD as well as in patients presented with acute myocardial infarction. fQRS is an available ECG-marker of local myocardial fibrosis. It seems to be a useful negative predictor in individuals with CAD, indicating an increased risk of life-threatening ventricular arrhythmias and recurrent cardiac events. The presence of fragmented QRS-complexes is associated with an increased in-hospital and long term (overall as well as cardiovascular) mortality. Routine evaluation of fQRS in standard ECG leads does not require additional resources, and will contribute to an improvement in diagnostics and risk stratification of stable CAD as well as myocardial infarction. Assessment of fQRS can be included in noninvasive diagnostic algorithm concerning CAD.

scholarly journals 566 Myocardial left ventricular mechanical uniformity and adverse cardiac events following myocardial infarction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Stiermaier ◽  
S J Backhaus ◽  
T Lange ◽  
A Koschalka ◽  
J L Navarra ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cox Regression ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Events ◽  
Prognostic Information ◽  
Ventricular Ejection Fraction ◽  
Cox Regression Analysis ◽  
Multicenter Observational Study ◽  
Adverse Cardiac Events

Abstract Background Despite limitations as a standalone parameter, left ventricular ejection fraction (LVEF) is the preferred measure of myocardial function and marker for post-infarction risk stratification. LV myocardial uniformity may provide superior prognostic information after acute myocardial infarction (AMI), which was subject of this study. Methods and Results: Consecutive patients with AMI (n = 1082; median age 63 years; 75% male) undergoing cardiac magnetic resonance (CMR) in median 3 days after infarction were included in this multicenter, observational study. Circumferential and radial uniformity ratio estimates (CURE and RURE) were derived from CMR feature-tracking as markers of mechanical uniformity (values between 0 and 1 with 1 reflecting perfect uniformity). The clinical endpoint was the 12-month rate of major adverse cardiac events (MACE), consisting of all-cause death, re-infarction, and new congestive heart failure. Patients with MACE (n = 73) had significantly impaired CURE [0.76 (IQR 0.67-0.86) versus 0.84 (IQR 0.76-0.89); p < 0.001] and RURE [0.69 (IQR 0.60-0.79) versus 0.76 (IQR 0.67-0.83); p < 0.001] compared to patients without events. While uniformity estimates did not provide independent prognostic information in the overall cohort, CURE below the median of 0.84 emerged as an independent predictor of outcome in post-infarction patients with LVEF >35% (n = 959) even after adjustment for established prognostic markers (hazard ratio 1.99; 95% confidence interval 1.06-3.74; p = 0.033 in stepwise multivariable Cox regression analysis). In contrast, LVEF was not associated with adverse events in this subgroup of AMI patients. Conclusions CMR-derived estimates of mechanical uniformity are novel markers for risk assessment after AMI and CURE provides independent prognostic information in patients with preserved or only moderately reduced LVEF.

scholarly journals Prediction of recurrent myocardial infarction in working-age patients

2020 ◽  
Vol 25 (8) ◽  
pp. 3909
Author(s):  
E. A. Shishkina ◽  
O. V. Khlynova ◽  
A. V. Tuev ◽  
I. A. Novikova ◽  
L. A. Nekrutenko
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Multivariate Regression ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Multivessel Coronary Artery Disease ◽  
Ventricular Ejection Fraction ◽  
Recurrent Myocardial Infarction ◽  
Working Age ◽  
Artery Disease

Aim. To determine independent predictors of recurrent myocardial infarction (MI) and to create a model for predicting recurrent coronary events in working-age patients.Material and methods. The study included 424 patients (median age 50 (43,5; 55,0) years). In 2017, all patients underwent treatment at the Perm Regional Vascular Center due to the first MI. We retrospectively analyzed the patient data with regard to medical history, comorbidities, diagnostic results, and treatment. After 2 years, information on recurrent MI was collected by analyzing data from electronic medical records of patients. Depending on the outcome, all patients were divided into two groups: with (n=78) and without (n=346) recurrent MI. Using the SPSS Statistics v.20, v.23 software package, we compared the central demographic, clinical, diagnostic parameters in the groups. Univariate and multivariate regression analyzes were performed to determine independent predictors of recurrent MI.Results. Multivariate regression established the following independent predictors of recurrent MI: left ventricular ejection fraction <50% (odds ratio (OR) 5,5, 95% confidence interval (CI) 1,56-19,34, p=0,008), anemia (OR=2,95, 95% CI 1,089- 9,765, p=0,046), multivessel coronary artery disease (OR 2,24, 95% CI 1,285- 3,909, p=0,004). Logistic regression model was created that allows predicting the 2-year risk of recurrent MI after the initial hospitalization with a sensitivity of 73,7% and a specificity of 79,6%.Conclusion. The results of this study suggest that risk stratification for recurrent MI in working-age patients may need to take into account decreased left ventricular ejection fraction, hemoglobin level, and multivessel coronary artery disease.

Abstract 4337: Best Outcome Predictor Post Myocardial Infarction: Can Blood Glucose Defeat Left Ventricular Ejection Fraction?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Silvia Monteiro ◽  
Natalia Antonio ◽  
Carolina Lourenço ◽  
Rogério Teixeira ◽  
Rui Batista ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Predictive Value ◽  
Ventricular Dysfunction ◽  
Multivariate Regression Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Events ◽  
Post Discharge ◽  
Ventricular Ejection Fraction

Introduction: Ventricular dysfunction in acute myocardial infarction (AMI) is a recognized predictor of in-hospital and post-discharge morbidity and mortality. Recently, admission hyperglycaemia has also been considered an important marker of poor prognosis in this patient population. Aim: To compare the predictive value of left ventricular dysfunction with admission glycaemia (GLY) on prognosis of AMI patients and to identify independent predictors of 1-year major acute cardiac events (MACE) and mortality. Population and methods: Retrospective analysis of 583 consecutive patients admitted to a single coronary care unit for AMI. Patients were followed during twelve months after AMI. Re-hospitalization by worsening heart failure, non programmed revascularization, new ACS and death were considered as MACE. Results: After multivariate analysis, age, previous diabetes, necrosis markers, and low ejection fraction (EF) were independent predictors of 1-year mortality, while PCI performance and admission GLY, in addition to parameters listed before were independent predictors of MACE at 1-year of follow-up. We then compared, by multivariate regression analysis, the predictive value of admission GLY and EF in this population. The receiver-operator curves showed that both parameters were equally predictive of both short and long-term MACE and mortality. Conclusion: In this population, admission GLY was as predictive of outcome as EF, a well recognized and strong prognosis determinant post-AMI. This fact, never before described, underlies the importance of metabolic abnormalities and its control in the prognosis of AMI patients.

scholarly journals Case report of an acute myocardial infarction after high-dose recreational nitrous oxide use: a consequence of hyperhomocysteinaemia?

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Thomas Oomens ◽  
Robert K Riezebos ◽  
Giovanni Amoroso ◽  
Remko S Kuipers
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Nitrous Oxide ◽  
Vitamin B12 ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
High Dose ◽  
Ventricular Ejection Fraction ◽  
Increased Risk ◽  
Very High

Abstract Background Nitrous oxide (N2O, laughing gas) is increasingly used as a recreational drug and is presumed relatively safe and innocent. It is often being used in combination with other substances, such as cannabis. Case summary A young adult attended the emergency room because of chest pain after recreational use of very high-dose nitrous oxide in combination with cannabis. Electrocardiography demonstrated ST-elevation in the anterior leads. Coronary angiography showed thrombus in the proximal and thrombotic occlusion of the distal left anterior descending coronary artery for which primary percutaneous coronary intervention was attempted. Thrombus aspiration was unsuccessful and the patient was further treated with a glycoprotein IIb/IIIa in addition to dual platelet therapy. Blood results showed low vitamin B12 and folic acid status with concomitant hyperhomocysteinaemia, a known cause of hypercoagulation. Transthoracic echocardiogram showed a moderately reduced left ventricular ejection fraction (LVEF). Three months later, an improvement in LVEF and no recurrent angina or symptoms of heart failure were noticed. Discussion We report a case of acute myocardial infarction secondary to very high-dose nitrous oxide abuse in combination with cannabis and possible hypoxia. We propose that severe hyperhomocysteinaemia secondary to nitrous oxide-induced vitamin B12 deficiency together with the vasoconstrictive effects of cannabis might pose a seriously increased risk for intracoronary, among others, thrombus formation. In conclusion, we contest the safety and innocence of recreational nitrous oxide (ab)use, notably in the context of other factors increasing the risk of coagulation.

Thirty-Five Day Impella 5.0 Support via Right Axillary Side Graft Cannulation for Acute Cardiogenic Shock

2013 ◽  
Vol 8 (4) ◽  
pp. 307-309 ◽  
Author(s):  
Mario A Castillo-Sang ◽  
Sunil M. Prasad ◽  
Jasvindar Singh ◽  
Gregory A. Ewald ◽  
Scott C. Silvestry
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Cardiogenic Shock ◽  
Artery Bypass ◽  
Complete Recovery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Severe Coronary Artery ◽  
Artery Disease

We describe the use of an Impella 5.0 for mechanical support in acute cardiogenic shock after an acute myocardial infarction. A 61-year-old man with a history of severe coronary artery disease who underwent coronary artery bypass grafting with ischemic cardiomyopathy presented with cardiogenic shock after an ST-elevation myocardial infarction. An Impella Recover LP 5.0 (Abiomed, Danvers, MA USA) was inserted via a right axillary side graft, using transesophageal echocardiographic and fluoroscopic guidance. The patient remained in the intensive care unit, where he required a tracheostomy to beweaned off the ventilator. He required renal replacement therapy with subsequent complete recovery. His Impella support was weaned, and on postoperative day 35, the device was removed. The patient developed axillary thrombosis the morning after removal, requiring thrombectomy. Discharge echocardiogram showed mild left ventricular enlargement with global hypokinesis and left ventricular ejection fraction of 25%. The Impella 5.0 device can safely and effectively be used in the long-term support of cardiogenic shock.

scholarly journals The outcomes of acute myocardial infarction patients comorbidity with hypertension and hyperhomocysteinemia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jumei Yan ◽  
Jiamin Zhou ◽  
Jun Huang ◽  
Hongyu Zhang ◽  
Zilin Deng ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Stay ◽  
Vital Signs ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Major Adverse Cardiovascular Events ◽  
Ventricular Ejection Fraction ◽  
Artery Disease

AbstractThis study investigated the outcomes and major adverse cardiovascular events (MACEs) incurred by acute myocardial infarction (AMI) patients comorbiding with hypertension and hyperhomocysteinemia (HHcy) during hospitalization and 1-year follow-up. 648 consecutive AMI patients were divided into four categories: (1) hypertension with Hcy ≥ 15 µmol/L; (2) hypertension with Hcy < 15 µmol/L; (3) no-hypertension with Hcy ≥ 15 µmol/L; (4) no-hypertension with Hcy < 15 µmol/L. Information taken from these case files included gender, past medical history, vital signs, laboratory examination, electrocardiogram, coronary angiography, cardiac ultrasound, and medicine treatment. The primary endpoints were duration of coronary care units (CCU) stay, duration of in-hospital stay, and MACEs during follow-up. Our data show that hypertension and HHcy have a synergistic effect in AMI patients, AMI comorbiding with hypertension and HHcy patients had more severe multi-coronary artery disease and more frequent non-culprit coronary lesions complete clogging, had a higher prevalence of pro-brain natriuretic peptide, and significant decreases in the left ventricular ejection fraction. These patients had significant increases in the duration of CCU stay and in-hospital stay, had significant increase in the rate of MACEs, had significant decreases in the survival rate during follow-up.

P879Discharge medication and 1-year outcomes in patients with myocardial infarction and nonobstructive coronary artery disease: a nationwide registry-based study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P M Azevedo ◽  
T Mota ◽  
J Bispo ◽  
J Guedes ◽  
D Carvalho ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Antiplatelet Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cox Regression Analysis ◽  
Artery Disease ◽  
The Impact

Abstract Introduction Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurs in 5% to 10% of all patients with myocardial infarction. Although these patients are often treated as if they had obstructive coronary artery disease (OCAD), optimal medical therapy for secondary prevention in MINOCA patients have not been prospectively studied. We hypothesize that the same treatment strategy as for OCAD is unlikely to be beneficial in MINOCA patients due to their heterogeneous nature. Purpose Characterize and assess the impact of discharge medication on 1-year mortality or hospitalization in patients with MINOCA. Methods Retrospective cohort study of consecutive patients with acute myocardial infarction (AMI) recorded in the Portuguese Registry of Acute Coronary Syndromes (ProACS) between 2010 and 1017. All patients who underwent coronary angiography and had no obstructive lesions (defined as <50% diameter stenosis) were included for analysis (n=829, 4.8% of a total of 17213). Patient demographics, clinical characteristics and medication at discharge were analyzed. The association between treatment and outcome was estimated by comparing treated and untreated groups using Cox proportional hazard models. The exposures considered were treatment at discharge with statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs), beta-blockers (BB), aspirin (ASA) or dual antiplatelet therapy (DAPT). The outcomes evaluated were 1-year all-cause mortality and 1-year hospitalization due to cardiovascular disease (CVD) Results 829 patients (54% male, mean age 65±13 years) were included. 67% had hypertension, 20% diabetes mellitus, 45% hyperlipidemia, 66% were overweight, 23% were current smokers, 5.5% had history of heart failure, 4.3% valvular heart disease, 8% cerebrovascular disease and 4.7% chronic kidney disease. The admission diagnosis was most frequently non-ST elevation MI (79.3%) and mean left ventricular ejection fraction (%) was 56±12. 4 patients died during hospitalization (0.5%). At discharge, aspirin was prescribed in 85.7% patients, clopidogrel in 54.8%, ticagrelor in 7.5%, DAPT in 57.7%, ACEi/ARB in 79.2%, beta-blocker in 69% and statins in 90.2%. 1-year mortality and 1-year CVD hospitalization was 3.8% and 9%, respectively. After adjusting for covariates in Cox regression analysis, we found no association between any medication at discharge and 1-year outcomes. Conclusion A high proportion of patients are prescribed antiplatelet therapy, including DAPT. We found no significant 1-year beneficial effect of treatment with statins, ACEi/ARBs, BB, aspirin or DAPT in MINOCA. This may be partially explained by the highly heterogenous population and relative short-term follow-up. In MINOCA patients, treatment should be individualized after an exhaustive diagnostic workup to identify the underlying cause (e.g. CAD with spontaneous autolysis of an intracoronary thrombus, myocarditis or takotsubo syndrome).

scholarly journals Does stress echocardiography add incremental value to baseline ejection fraction for the early identification of candidates for implantable defibrillators?

Open Heart ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. e001053
Author(s):  
Josephine Muhrbeck ◽  
Elif Gunyeli ◽  
Eva Andersson ◽  
Mahbubul Alam ◽  
Viveka Frykman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Stress Echocardiography ◽  
Peak Systolic Velocity ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Stunned Myocardium ◽  
Ventricular Ejection Fraction ◽  
Increased Risk

ObjectiveA reduction in left ventricular ejection fraction (EF) remains the strongest indicator of increased risk of sudden cardiac death after an acute myocardial infarction (AMI). Guidelines recommend that patients with an EF ≤35%, 6–12 weeks after AMI should be considered for implantable cardioverter defibrillator (ICD) therapy. Stress echocardiography is a safe method to detect viability in a stunned myocardium. The purpose of this study was to investigate if stress echocardiography early after AMI could identify ICD candidates before discharge.MethodsNinety-six patients with EF ≤40% early after AMI were prospectively included in a cohort study, and investigated by baseline and stress echocardiography before discharge. Follow-up echocardiography was performed after 3 months. EF, mitral annular plane systolic excursion (MAPSE) and peak systolic velocity (PSV) were determined for each examination.ResultsThere were 80 (83%) patients who completed the baseline, stress and follow-up echocardiography. Among them there were 32 (40%) patients who met the ICD criteria of EF ≤35% at 3 months. For these patients, EF, MAPSE and PSV were significantly lower than for those patients who recovered. The area under the receiver operating characteristic curve (AUC) was 85% (95% CI 0.74 to 0.94) for baseline EF to predict non-recovery. None of the other variables had a higher AUC.ConclusionPatients who met the ICD criteria of EF ≤35% at 3 months after myocardial infarction had lower EF, MAPSE and PSV on baseline and stress echocardiograph before discharge. Stress echocardiography did not add additional value in predicting non-recovery.

scholarly journals Prognostic Value of MicroRNAs in Patients after Myocardial Infarction: A Substudy of PRAGUE-18

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
M. Hromádka ◽  
V. Černá ◽  
M. Pešta ◽  
A. Kučerová ◽  
J. Jarkovský ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Plasma Levels ◽  
Troponin T ◽  
Statistical Significance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Major Adverse Cardiovascular Events ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death ◽  
Increased Risk

Background. The evaluation of the long-term risk of major adverse cardiovascular events and cardiac death in patients after acute myocardial infarction (AMI) is an established clinical process. Laboratory markers may significantly help with the risk stratification of these patients. Our objective was to find the relation of selected microRNAs to the standard markers of AMI and determine if these microRNAs can be used to identify patients at increased risk. Methods. Selected microRNAs (miR-1, miR-133a, and miR-499) were measured in a cohort of 122 patients from the PRAGUE-18 study (ticagrelor vs. prasugrel in AMI treated with primary percutaneous coronary intervention (pPCI)). The cohort was split into two subgroups: 116 patients who did not die (survivors) and 6 patients who died (nonsurvivors) during the 365-day period after AMI. Plasma levels of selected circulating miRNAs were then assessed in combination with high-sensitivity cardiac troponin T (hsTnT) and N-terminal probrain natriuretic peptide (NT-proBNP). Results. miR-1, miR-133a, and miR-499 correlated positively with NT-proBNP and hsTnT 24 hours after admission and negatively with left ventricular ejection fraction (LVEF). Both miR-1 and miR-133a positively correlated with hsTnT at admission. Median relative levels of all selected miRNAs were higher in the subgroup of nonsurvivors (N=6) in comparison with survivors (N=116), but the difference did not reach statistical significance. All patients in the nonsurvivor subgroup had miR-499 and NT-proBNP levels above the cut-off values (891.5 ng/L for NT-proBNP and 0.088 for miR-499), whereas in the survivor subgroup, only 28.4% of patients were above the cut-off values (p=0.001). Conclusions. Statistically significant correlation was found between miR-1, miR-133a, and miR-499 and hsTnT, NT-proBNP, and LVEF. In addition, this analysis suggests that plasma levels of circulating miR-499 could contribute to the identification of patients at increased risk of death during the first year after AMI, especially when combined with NT-proBNP levels.

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