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Predicting Recovery of Myocardial Function by Electrocardiography after Acute Infarction

Authors


  • This study was supported by grants from the Finnish Foundation for Cardiovascular Research, Finska Läkaresällskapet, the Waldemar von Frenckell Foundation, Helsinki University Central Hospital Research Funds (EVO grant), the Instrumentarium Foundation, the Aarne Koskelo Foundation; and the Medicine Fund of Helsinki University, Helsinki, Finland.

Address for correspondence: Minna M. Kylmälä, M.D., Division of Cardiology, Helsinki University Central Hospital, P.O.B. 340, 00029 HUS, Finland. Fax: + 358 9 5042412; E-mail: minna.kylmala@hus.fi

Abstract

Background

In acute ischemic left ventricular (LV) dysfunction, distinguishing viable myocardium is clinically important.

Methods

Body surface potential mapping (Electrocardiography [ECG] with 123 leads), was recorded in 62 patients with acute coronary syndrome (ACS). ECG variables were computed from de- and repolarization phases. LV segmental wall motion was assessed by echocardiography acutely and after 1 year.

Results

The number of dysfunctional segments (DFS) diminished during follow-up in 37 patients (recovery group) and remained the same or increased in 25 patients (nonrecovery group). Acutely, DFS was 5.7 ± 2.1 versus 4.4 ± 2.4 (P = 0.02), and peak CK-MBm 141 ± 157 versus 156 ± 167 μg/L (P = 0.78) in the recovery versus nonrecovery group. At follow-up, DFS was 1.9 ± 1.7 versus 6.5 ± 2.6 (P < 0.001). The best ECG variable to predict decrease in DFS depended on the region of acute LV dysfunction: The best variable in the left anterior descending region was the integral of the first QRS integral (area under the curve [AUC] 0.82, P = 0.002); in the right coronary artery region, this was the integral of the ST segment (AUC 0.98, P = 0.003); and in the left circumflex region, the area including the ST segment and the T wave (AUC 0.97, P = 0.006).

Conclusions

In ACS patients, computed ECG variables predict recovery of LV function from ischemic myocardial injury, even in the presence of comparable CK-MBm release and LV dysfunction.

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