Left ventricular and coronary angiographic anatomy. Relationship to ventricular irritability in the late hospital phase of acute myocardial infarction.

Schulze, R; Humphries, J.O'Neal; Griffith, Lawrence S.C.; Ducci, H; Achuff, Stephen C.; Baird, Michael G.; Mellits, E. David; Pitt, Bertram

doi:10.1161/01.cir.55.6.839

Cited by 69 publications

(6 citation statements)

References 23 publications

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“…22 We did not find a similar relationship between the extent of cor-VOL 60, No 6, DECEMBER 1979 onary disease and arrhythmias in patients with VAP. However, the presence of arrhythmias correlates with the severity of ischemia measured by ST-segment elevation and AR during episodes of VAP.…”

Section: Discussionmentioning

confidence: 57%

Arrhythmias in variant angina pectoris. Relationship of arrhythmias to ST-segment elevation and R-wave changes.

Kerin¹,

Rubenfire²,

Naini³

et al. 1979

Circulation

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SUMMARY Twenty-six patients with variant angina pectoris (VAP) were studied 1) to determine whether the degree of ST-segment elevation and R-wave changes correlate with the development of arrhythmias; and 2) to evaluate the relationship between the prevalence of arrhythmias, the severity of coronary artery disease, left ventricular function and wall motion.Serious arrhythmias were found in 12 patients (46%) (ventricular fibrillation in two, ventricular tachycardia in four, ventricular premature complexes [VPCs] [> 5 VPCs/min, multifocal and R-on-T phenomenon] in four, and second-and third-degree atrioventricular block in three). All twelve patients with arrhythmias had ST-segment elevation > 0.4 mV during VAP (range 0.4-1.6 mV). R-wave amplitude was compared before and during episodes of VAP and expressed as %AR. An increase in R 10% was seen in 10 of 12 patients with arrhythmias (group 1) and in only six of 14 patients without arrhythmias (group 2) (p < 0.05).Twenty-three of the 26 patients underwent coronary angiography and ventriculography, and one was examined by autopsy. Sixteen patients in this group had single or multiple high-grade obstructive lesions, while the remaining eight had normal coronary arteriograms.Arrhythmias were more common in the group with coronary obstructive disease (66%) than in the group with normal coronary arteriograms (44%). There was no significant difference between patients with arrhythmias (group I) and those without arrhythmias (group 2) in the coronary arteriographic score or left ventricular ejection fraction.The data suggest that arrhythmias occur frequently during VAP and correlate well with the degree of STsegment elevation and %AR. In patients with VAP, arrhythmias are not contingent upon preexisting coronary artery disease or left ventricular ejection fraction, and are more commonly detected in patients with normal coronary arteriograms. IN 1959 and1960, Prinzmetal et al.' 2 delineated a variant form of angina pectoris (VAP) that primarily differs from Heberden's classic angina pectoris in that the pain is frequently spontaneous, occurs at rest, and is unrelated to physical activity or emotion. The pain in VAP generally lasts longer and may be more severe than in classic angina pectoris. Attacks tend to be cyclic, often recurring at a specific time of day. Episodes of pain are accompanied by transient STsegment elevation with reciprocal changes in the standard leads, as opposed to typical ST-segment depression. VAP has been reported3-7 in patients with normal coronary arteriograms,1 2, 8 as well as in those with angiographically demonstrated focal lesions that affect the proximal segment of the coronary arteries.Abnormalities of rhythm and conduction may be associated with VAP.6 16 During pain, the wide spectrum of reported arrhythmias includes second-and third-degree atrioventricular block,6' 7, 9, 10 ventricular tachycardia and ventricular fibrillation,10' 11 ventricular premature complexes (VPCs),13' 14 ventricular asystole'5 and atrial fibrillation. 16 We studied ...

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Section: Discussionmentioning

confidence: 57%

Arrhythmias in variant angina pectoris. Relationship of arrhythmias to ST-segment elevation and R-wave changes.

Kerin¹,

Rubenfire²,

Naini³

et al. 1979

Circulation

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“…'6 Multigated Blood Pool Imaging After the delayed 201T images were obtained, equilibrium-gated blood pool imaging was performed at rest to determine left ventricular ejection fraction and segmental wall motion patterns. Patients were injected with unlabeled stannous pyrophosphate (Mallinckrodt, Inc.), followed 30 minutes later by 20 patients, the inferior and inferoapical segments were considered. Also, in four patients (two from each group), the mid-high posterolateral wall was designated an infarct-related segment because angiography revealed that the circumflex artery was the infarct vessel.…”

Section: Exercise Myocardial Scintigraphymentioning

confidence: 99%

Precordial ST-segment depression during acute inferior myocardial infarction: clinical, scintigraphic and angiographic correlations.

Gibson¹,

Crampton²,

Watson³

et al. 1982

Circulation

163

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“…For example, if R on T is present, grade 5 is assigned regardless of ventricular extrasystoles frequency or other complex features. The three frequency categories (0, > 0 but <30, >30 ventricular extrasystoles per hour) and 717 BHJ389/80 Table 1 The Lown grading system for ventricular arrhythmias Lown grade Definition 0 No ventricular premature depolarisations 1 Less than 30 ventricular extrasystoles per hour 2 30 or more ventricular extrasystoles per hour 3 Multiform ventricular extrasystoles 4A Two consecutive ventricular extrasystoles 4B…”

mentioning

confidence: 99%

Analysis of prognostic significance of ventricular arrhythmias after myocardial infarction. Shortcomings of Lown grading system.

Bigger¹,

Weld²

1981

Heart

104

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The Lown grading system for ventricular arrhythmias has been used in observational and experimental studies of ischaemic heart disease. This grading system uses three levels of ventricular premature depolarisation frequency and four complex features to assign patients to one of seven grades. We tested several of the major assumptions of the Lown grading system in a group of 400 patients who had recently experienced acute myocardial infarction. The Lown grading system assumes that the frequency of ventricular extrasystoles exerts a negligible risk force in patients who have complex ventricular extrasystoles. We found, however, that the frequency of ventricular extrasystoles contributed significant additional risk for cardiac death even in the three highest Lown grades, 4A, 4B, and 5. The Lown grading system assumes that, of the four complex features used, R on T ventricular extrasystoles have the greatest risk for subsequent cardiac death. We found that paired ventricular extrasystoles and ventricular tachycardia had more prognostic significance than R on T ventricular extrasystoles. It is important for prognostic stratification that subgroups which are merged into a given Lown grade should be relatively homogeneous with respect to outcome. We found a lack of homogeneity in the three highest Lown grades. Grade 5 contained 16 subgroups with a mortality risk which ranged from 0 to 75 per cent; statistically significant differences in subsequent mortality were found among these subgroups. Most of the shortcomings of the Lown grading system in our acute myocardial infarction population resulted from failure to give sufficient weight to ventricular extrasystoles frequency and to repetitive ventricular extrasystoles.

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Left ventricular and coronary angiographic anatomy. Relationship to ventricular irritability in the late hospital phase of acute myocardial infarction.

Cited by 69 publications

References 23 publications

Arrhythmias in variant angina pectoris. Relationship of arrhythmias to ST-segment elevation and R-wave changes.

Arrhythmias in variant angina pectoris. Relationship of arrhythmias to ST-segment elevation and R-wave changes.

Precordial ST-segment depression during acute inferior myocardial infarction: clinical, scintigraphic and angiographic correlations.

Analysis of prognostic significance of ventricular arrhythmias after myocardial infarction. Shortcomings of Lown grading system.

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