New Insights Into the Use of the 12-Lead Electrocardiogram for Diagnosing Acute Myocardial Infarction in the Emergency Department

Miranda, David; Lobo, Angie S.; Walsh, Barbara C.; Sandoval, Yader; Smith, Stephen W.

doi:10.1016/j.cjca.2017.11.011

Cited by 75 publications

(55 citation statements)

References 74 publications

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“…Accordingly, several authors called for a new paradigm shift from STEMI/non-STEMI to ACO-MI/non-ACO-MI [17] , [18] , [19] , as ACO can be reliably recognized with the help of many other ECG findings, such as minor STE not fulfilling STEMI criteria [18] , STE disproportionate to preceding QRS [19] , [20] , unusual patterns with contiguous leads showing opposite ST deviations [21] and some patterns not showing STE at all [22] , [23] . However, it is uncertain whether this new approach would result in better identification of the patients who need acute reperfusion therapy and/or whether the ECG has sufficient diagnostic power to go beyond established STEMI criteria.…”

Section: Introductionmentioning

confidence: 99%

DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction (DIFOCCULT Study)

Aslanger

Yıldırımtürk

Şimşek

et al. 2020

IJC Heart & Vasculature

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Background Although ST-segment elevation (STE) has been used synonymously with acute coronary occlusion (ACO), current STE criteria miss nearly one-third of ACO and result in a substantial amount of false catheterization laboratory activations. As many other electrocardiographic (ECG) findings can reliably indicate ACO, we sought whether a new ACO/non-ACO myocardial infarction (MI) paradigm would result in better identification of the patients who need acute reperfusion therapy. Methods A total of 3000 patients were enrolled in STEMI, non-STEMI and control groups. All ECGs were reviewed by two cardiologists, blinded to any outcomes, for the current STEMI criteria and other subtle signs. A combined ACO endpoint was composed of peak troponin level, troponin rise within the first 24 h and angiographic appearance. The dead or alive status was checked from hospital records and from the electronic national database. Results In non-STEMI group, 28.2% of the patients were re-classified by the ECG reviewers as having ACO. This subgroup had a higher frequency of ACO, myocardial damage, and both in-hospital and long-term mortality compared to non-STEMI group. A prospective ACOMI/non-ACOMI approach to the ECG had superior diagnostic accuracy compared to the STE/non-STEMI approach in the prediction of ACO and long-term mortality. In Cox-regression analysis early intervention in patients with non-ACO-predicting ECGs was associated with a higher long-term mortality. Conclusions We believe that it is time for a new paradigm shift from the STEMI/non-STEMI to the ACOMI/non-ACOMI in the acute management of MI. (DIFOCCULT study; ClinicalTrials.gov number, NCT04022668.)

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Section: Introductionmentioning

confidence: 99%

DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction (DIFOCCULT Study)

Aslanger

Yıldırımtürk

Şimşek

et al. 2020

IJC Heart & Vasculature

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“…The resting standard 12‐lead ECG remains readily available around the world and, along with history and physical examination, is considered essential by most emergency room/urgent care physicians and cardiologists in the initial clinical assessment of a patient with cardiorespiratory complaints. This simple diagnostic tool can provide useful evidence‐based predictors for a variety of important cardiac conditions, such as left ventricular hypertrophy, myocardial infarction, and left atrial enlargement, to name but a few . Even when undertaken by noncardiologists (such as primary care physicians, emergency room physicians, hospitalists), processes usually exist to ensure prompt formal interpretation by a cardiologist.…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic predictors of pacemaker battery depletion: Diagnostic sensitivity, specificity, and clinical risk

Carlson

Marine

Love

et al. 2019

Pacing Clinical Electrophis

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Background: Pacemaker battery depletion triggers alert for replacement notification and results in automatic reprogramming, which has been shown to be associated with relevant cardiorespiratory symptoms and adverse clinical events.Objective: Determine if electrocardiogram (ECG) pacing features may be predictive of pacemaker battery depletion and clinical risk.Methods: This is an ECG substudy of a cohort analysis of 298 subjects referred for pacemaker generator replacement from 2006 to 2017. Electronic medical record review was performed; clinical, ECG, and pacemaker characteristics were abstracted. We applied two ECG prediction rules for pacemaker battery depletion that are relevant to all major pacemaker manufacturers except Boston Scientific and MicroPort: (1) atrial pacing not at a multiple of 10 and (2) nonsynchronous ventricular pacing not at a multiple of 10, to determine diagnostic sensitivity, specificity, and risk in applicable ECG subjects. Results:We excluded 32 subjects not at replacement notification or duplicate surgeries. Overall, 176 of 266 subjects (66.2%) demonstrated atrial pacing or nonsynchronous ventricular pacing on preoperative ECG. When utilizing both rules, 139 of 176 preoperative ECGs and 12 of 163 postoperative ECGs met criteria for battery depletion yielding reasonable sensitivity (79.0%), high specificity (92.6%), and a positive likelihood ratio of 11.6:1. These rules were associated with significant increase in cardiorespiratory symptoms (P < .001) and adverse clinical events (P < .025). Conclusions:The "Rules of Ten" provided reasonable sensitivity and specificity for detecting replacement notification in pacemaker subjects with an applicable ECG. This ECG tool may help clinicians identify most patients with pacemaker battery depletion at significant clinical risk.

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“…First, HR is related with the electrical and mechanical activities of the heart. [ 14 15 ] To determine the effects of HR in electromechanical coupling time, the electromechanical coupling time with or without HR correction in SBHF patients and CONs was analyzed in our study. The results showed that the electromechanical coupling durations were all significant longer in SBHF patients than those in CONs with or without HR correction [ Supplementary Table 1 ], which indicates that HR has no significant influence in the prolongation of electromechanical coupling in the SBHF group.…”

Section: Discussionmentioning

confidence: 99%

Excitation-Contraction Coupling Time is More Sensitive in Evaluating Cardiac Systolic Function

Gao

Zhu

et al. 2018

Chinese Medical Journal

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Background:Pressure overload-induced myocardial hypertrophy is a key step leading to heart failure. Previous cellular and animal studies demonstrated that deteriorated excitation–contraction coupling occurs as early as the compensated stage of hypertrophy before the global decrease in left ventricular ejection fraction (LVEF). This study was to evaluate the cardiac electromechanical coupling time in evaluating cardiac systolic function in the early stage of heart failure.Methods:Twenty-six patients with Stage B heart failure (SBHF) and 31 healthy controls (CONs) were enrolled in this study. M-mode echocardiography was performed to measure LVEF. Tissue Doppler imaging (TDI) combined with electrocardiography (ECG) was used to measure cardiac electromechanical coupling time.Results:There was no significant difference in LVEF between SBHF patients and CONs (64.23 ± 8.91% vs. 64.52 ± 5.90%; P = 0.886). However, all four electromechanical coupling time courses (Qsb: onset of Q wave on ECG to beginning of S wave on TDI, Qst: onset of Q wave on ECG to top of S wave on TDI, Rsb: top of R wave on ECG to beginning of S wave on TDI, and Rst: top of R wave on ECG to top of S wave on TDI) of SBHF patients were significantly longer than those of CONs (Qsb: 119.19 ± 35.68 ms vs. 80.30 ± 14.81 ms, P < 0.001; Qst: 165.42 ± 60.93 ms vs. 129.04 ± 16.97 ms, P = 0.006; Rsb: 82.43 ± 33.66 ms vs. 48.30 ± 15.18 ms, P < 0.001; and Rst: 122.37 ± 36.66 ms vs. 93.25 ± 16.72 ms, P = 0.001), and the Qsb, Rsb, and Rst time showed a significantly higher sensitivity than LVEF (Rst: P =0.032; Rsb: P = 0.003; and Qsb: P = 0.004).Conclusions:The cardiac electromechanical coupling time is more sensitive than LVEF in evaluating cardiac systolic function.

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New Insights Into the Use of the 12-Lead Electrocardiogram for Diagnosing Acute Myocardial Infarction in the Emergency Department

Cited by 75 publications

References 74 publications

DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction (DIFOCCULT Study)

DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction (DIFOCCULT Study)

Electrocardiographic predictors of pacemaker battery depletion: Diagnostic sensitivity, specificity, and clinical risk

Excitation-Contraction Coupling Time is More Sensitive in Evaluating Cardiac Systolic Function

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