Document Detail

Reciprocal ECG change in reperfused ST-elevation myocardial infarction is associated with myocardial salvage and area at risk assessed by cardiovascular magnetic resonance.
MedLine Citation:
PMID:  24014279     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: ST-elevation acute myocardial infarction (STEMI) is frequently associated with reciprocal ST depression in contralateral ECG leads. The relevance of these changes is debated. This study examined whether reciprocal ECG changes in STEMI reflect larger myocardial area at risk (AAR) and/or infarct size.
DESIGN: Patients were stratified by presence of reciprocal change on the presenting ECG, defined as ≥ 1 mm ST depression in ≥ 2 inferior leads for anterior STEMI, or ≥ 2 anterior leads for inferior STEMI. Infarcted tissue was defined on late enhancement and AAR on T2-weighted cardiovascular magnetic resonance (CMR).
SETTING: Patients with reperfused first STEMI underwent CMR within 3 days of presentation.
MAIN OUTCOME MEASURES: In addition to AAR and infarct mass, myocardial salvage was calculated as (AAR mass-infarct mass) and salvage index as myocardial salvage/AAR mass.
RESULTS: Thirty-five patients were analysed (n=35). Patients with reciprocal ECG changes (n=19) had higher AAR mass than those without (42 g vs 29 g, p<0.001), and higher myocardial salvage (27 g vs 9 g, p<0.001) and myocardial salvage index (61% vs 17%, p<0.001) but similar infarct size (16 g vs 20 g, p=0.3) and ejection fraction (43% vs 45%, p=0.5).
CONCLUSIONS: STEMI patients with reciprocal ECG changes have larger AAR, higher myocardial salvage and salvage index than those without. Reciprocal changes appear to be a marker of increased ischaemic myocardium at risk and indicate the potential for increased salvage with emergency revascularisation. Reciprocal changes showed no relationship to infarct size, which may be influenced by ischaemia time and other treatment factors.
Ananth Kidambi; Adam N Mather; Akhlaque Uddin; Manish Motwani; David P Ripley; Bernhard A Herzog; Adam McDiarmid; Julian Gunn; Sven Plein; John P Greenwood
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2013-09-07
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  99     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-10-17     Completed Date:  2013-12-11     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  1658-62     Citation Subset:  AIM; IM    
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MeSH Terms
Cardiac Imaging Techniques*
Magnetic Resonance Imaging*
Middle Aged
Myocardial Infarction / diagnosis*,  pathology,  physiopathology*,  surgery
Myocardial Reperfusion
Prospective Studies
Risk Assessment
Grant Support
FS/10/62/28409//British Heart Foundation

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