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1.
J Electrocardiol ; 49(3): 292-9, 2016.
Article in English | MEDLINE | ID: mdl-27040921

ABSTRACT

BACKGROUND: In the Sclarovsky-Birnbaum Ischemia Severity Grading System for patients with ST-segment elevation myocardial infarction (STEMI), "Terminal QRS distortion" is considered as "Grade III". This evidence for most severe ischemia is associated with cardiovascular magnetic resonance imaging (CMR) markers of myocardial damage in the subacute phase. Our aim was to assess whether terminal QRS distortions on the initial electrocardiogram (ECG) is predictive for infarct size (IS) and left ventricular ejection fraction (LVEF) at 4months in anterior versus infarct locations. METHODS: Patient data of the HEBE, GIPS III and MAST, were pooled. ECGs of 411 STEMI patients were classified as absence (Grade II) or presence (Grade III) of terminal QRS distortion according to Sclarovsky-Birnbaum grading. CMR was performed at approximately 4months and included IS and LVEF. RESULTS: Grade III ischemia was present in 142 of 411 (35%) patients and was more frequently observed with inferior STEMI (P=0.01). In the total cohort and in anterior STEMI, no difference in LVEF or IS was observed between the two Grades. Whereas, in inferior STEMI Grade III was associated with a larger IS (P<0.01) and also, a trend towards a lower LVEF was observed (P=0.09). CONCLUSION: In inferior STEMI, terminal QRS distortion on the initial ECG is associated with a larger IS at approximately 4months, and can be used to identify a high-risk population in the acute phase. Also, a Grade III was associated with a trend towards a lower LVEF.


Subject(s)
Artifacts , Electrocardiography/methods , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/diagnosis , Severity of Illness Index , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/etiology , Algorithms , Diagnosis, Computer-Assisted/methods , Female , Humans , Longitudinal Studies , Male , Middle Aged , Reproducibility of Results , Sensitivity and Specificity , Statistics as Topic , Stroke Volume
2.
J Electrocardiol ; 46(3): 229-34, 2013.
Article in English | MEDLINE | ID: mdl-23567089

ABSTRACT

INTRODUCTION: Having a bedside tool such as the ECG to assess the myocardial area at risk in a patient presenting with an ST-elevation myocardial infarction would be of great value to the clinician because this could give an insight in the efficiency of intervention therapy and the left ventricular rest function. MATERIALS AND METHODS: From the MAST database (n=106), we included 84 patients, all meeting the STEMI criteria, with a first anterior and/or inferior STEMI. From the admission ECG the Aldrich and Selvester scores were measured and the combined Hellemond score was calculated and correlated with the Cardiac Magnetic Resonance (CMR) estimated endocardial surface area (ESA) using the Spearman coefficient. RESULTS: The correlation between the Aldrich score was r=0.55 (p-value<0.0001) and Hellemond score r=0.45 (p-value<0.0001) with ESA. After exclusion of lateral involvement the correlation increased to 0.62 (p-value<0.0001) for the Aldrich and to 0.49 (p-value<0.0001) for the Hellemond score. CONCLUSION: The additional ECG estimation of infarcted myocardium does not improve the ECG estimation of ischemic myocardium to CMR-based ESA estimation of the myocardial area at risk. The Aldrich score could be improved for STEMIs with lateral involvement.


Subject(s)
Algorithms , Diagnosis, Computer-Assisted/statistics & numerical data , Electrocardiography/statistics & numerical data , Magnetic Resonance Imaging, Cine/statistics & numerical data , Myocardial Infarction/diagnosis , Myocardial Infarction/epidemiology , Severity of Illness Index , Diagnosis, Computer-Assisted/methods , Electrocardiography/methods , Female , Humans , Magnetic Resonance Imaging, Cine/methods , Male , Middle Aged , Netherlands/epidemiology , Prevalence , Reproducibility of Results , Risk Factors , Sensitivity and Specificity , Statistics as Topic
3.
Neth J Med ; 68(10): 328, 2010 Oct.
Article in English | MEDLINE | ID: mdl-21071782

ABSTRACT

Masked hypertension is normal blood pressures (BP) in a clinical setting and high BP during ambulatory monitoring. Although these patients are at higher cardiovascular risk, there is still no clear consensus definition of masked hypertension.


Subject(s)
Hypertension/diagnosis , Hypertension/psychology , Blood Pressure , Blood Pressure Monitoring, Ambulatory , Humans , Hypertension/complications , Hypertrophy, Left Ventricular/complications , Male , Middle Aged , Risk Factors
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