Chinualumogu Nwakile

Prognostic significance of abnormal P wave morphology and PR-segment displacement after ST-elevation myocardial infarction

INTRODUCTION Atrial infarction is uncommonly diagnosed and data on its significance are limited. Its incidence in ST-elevation myocardial infarction (STEMI) reportedly ranges from 0.7-42%. Certain atrial ECG changes, such as abnormal P wave morphology suggestive of atrial involvement have been associated with 90-day mortality after STEMI. However, whether atrial ECG changes are associated with short (30-day) or long-term (1-year) mortality have not been studied. METHODS We examined index ECG in 224 consecutive STEMI. Demographics, clinical variables, peak troponin I, ejection fraction, and angiographic data were collected. Atrial ECG patterns were examined and correlated with mortality. RESULTS Length of stay was longer with abnormal P waves (p=0.008) or PR displacement in any lead (p=0.003). Left main coronary disease was more prevalent with abnormal P wave (p=0.045). Abnormal P wave morphology in any lead was associated with higher 30-day (OR 3.09 (1.35-7.05)) and 1-year mortality (OR 5.33 (2.74-10.36)). PR displacement in any lead was also associated with increased 30-day (OR 2.33 (1.03-5.28)) and 1-year mortality (OR 6.56 (3.34-12.86)). Abnormal P wave, PR depression in II, III and AVF, and elevation in AVR or AVL were associated with increased 1-year mortality (OR 12.49 (5.2-30.0)) as was PR depression in the precordial leads (OR 21.65 (6.82-68.66)). After adjusting for age, ejection fraction, peak troponin I, and left main disease, PR displacement in any lead was associated with increased 1-year mortality (adjusted OR 6.22 (2.33-18.64)). CONCLUSION PR segment displacement in any lead, found in 31% of patients with STEMI, independently predicted 1-year mortality.

Utility of the QT interval in predicting outcomes in patients presenting to the emergency department with chest pain.

ObjectivesThe aim of this study was to investigate whether prolongation of the heart rate-corrected QT interval (QTc) is an independent risk factor for predicting future acute coronary syndrome (ACS) occurrence or mortality in patients with at least one cardiac risk factor presenting with chest pain to the emergency department (ED). MethodsThis is a single-center, retrospective study of patients presenting with chest pain to the ED of Einstein Medical Center, Philadelphia, between 2011 and 2012. Proportional hazards models were used to calculate hazard ratios (HRs) for occurrence of ACS or death within 1 year. Kaplan–Meier curves were used to determine the time to event for QTc low (<460 ms) versus QTc high (≥460 ms) groups. ResultsA total of 595 patients met the inclusion criteria. Older age, hypertension, diabetes mellitus, and hyperlipidemia were more common in the QTc high group. Patients in the QTc high group were more likely to experience subsequent ACS or death (HR 8.12, 95% confidence interval 4.00–16.72), even after adjusting for traditional cardiac risk factors (HR 7.68, 95% confidence interval 3.57–16.61). ConclusionQTc prolongation at ED presentation with chest pain and at least one cardiac risk factor predicts subsequent ACS and death.

Significance of QRS duration in non-ST elevation myocardial infarction

Part of the Cardiology Commons This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson Universitys Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship.Significance of QRS duration in non-ST elevation myocardial infarction.

QRS DURATION AND LEFT VENTRICULAR EJECTION FRACTION IN NON ST SEGMENT ELEVATION MYOCARDIAL INFARCTION

Non-traditional EKG parameters as pattern of QRS or its duration (QRSd) have been investigated in acute coronary syndrome. Following an infarction, the heart attempts to compensate for myocardial loss through remodeling which alters the ejection fraction over time. Our objective is to evaluate the

ELECTROCARDIOGRAPHIC CHANGES CONSISTENT WITH ATRIAL INFARCTION IS A POTENTIAL INDEPENDENT PREDICTOR OF 30 DAY AND 1 YEAR MORTALITY IN PATIENTS WITH ACUTE ST-ELEVATION MYOCARDIAL INFARCTION

Atrial Infarction is an uncommonly diagnosed disease and data on its significance are limited. Its incidence in patients with ST-segment elevation myocardial infarction (STEMI) reportedly ranges from 0.7-52%. Several atrial infarction electrocardiographic (ECG) patterns have been described but none

QRS duration predicts 30 day mortality following ST elevation myocardial infarction

Studies have demonstrated an association between QRS duration and long term mortality after myocardial infarction [1,2]. However, there remains a scarcity of data on QRS duration after ST elevation myocardial infarction (STEMI) and its association with mortality.We investigatedwhether QRS duration during STEMI hospitalization could predict 30-day and one yearmortality. A secondary objective was to determine the relationship between prolonged QRS and occurrence of inpatient ventricular arrhythmias. Five hundred and fifty three patients admitted to Einstein Medical Center, Philadelphia from August 1, 2006 to August 31, 2011 with a diagnosis of STEMI were screened. The study protocol was approved by our Institutional Review Board. The author(s) of this manuscript have certified that they comply with the principles of ethical publishing in the International Journal of Cardiology. STEMI was diagnosed on the basis of cardiac symptoms and electrocardiographic changes consisting of ST elevation in two contiguous leads in accordance with the guidelines [3]. Patients with any of the following were excluded: