Relation of collateral circulation with reciprocal changes in patients with acute ST-elevation myocardial infarction

Radwan, Hanan; Ahmed, Ahmed Abd Elmoneim; Ammar, A.H.; Roshdy, Hisham Samir

doi:10.1016/j.jelectrocard.2020.03.011

Cited by 6 publications

(6 citation statements)

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“…Their study team reported a signi cantly higher prevalence of proximal LAD, distal RCA, and distal LCX obstruction in patients with mirror changes than those without mirror changes. As a result, there was a relationship between ST-segment depression and multi-vessel involvement [12]. El Atroush et al (2012) also reported signi cantly higher multi-vessel involvement in the group with STsegment depression [7].…”

Section: Discussionmentioning

confidence: 94%

“…A retrospective study carried out by Vaidya et al (2017) aimed to investigate the role of ECG mirror changes in predicting lateral blood ow to the infarct area [11]. Similarly, Radwan et al (2020) studied the relationship between lateral circulation and ST-segment changes [12], but neither study found a signi cant correlation between ST-segment depression and the presence of lateral vessels. Vaidya et al…”

Section: Discussionmentioning

confidence: 99%

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Mirror changes in inferior wall myocardial infarction and its relationship with coronary lesions in non-infarcted areas using angiographic and electrocardiographic findings

Faramarzzadeh

Nobakht

Behnemoon

et al. 2023

Preprint

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Background and Objectives The study examined mirror changes in inferior wall myocardial infarction and its relationship with coronary lesions in non-infarcted areas using angiographic and electrocardiographic findings. Methods This retrospective study analyses 270 patients with inferior wall myocardial infarction, 135 of whom had mirror changes, and 135 had no. The patients' electrocardiograms, echocardiography results, and angiography results were examined. Ejection fraction, thrombolytic response, coronary artery occlusion, occlusion rate, and the number of occluded vessels were evaluated in two patients with and without mirror changes. Results We found no significant relationship between mirror changes and lateral arteries (P = 0.091). The findings indicated a connection between ST-segment depression and the existence of stenosis in the irresponsible vessel (P = 0.026). Also, in those patients exhibiting ST-segment depression, the degree of stenosis was more pronounced in the responsible vessel (P = 0.003). Additionally, no relationship was reported between multi-vessel involvement and ST-segment depression (P = 0.462). There was a noteworthy relationship between ST-segment depression and thrombolytic response (P = 0.002). Moreover, the results indicated that there was no substantial correlation between the EF level and the occurrence of ST-segment depression (P = 0.209). Conclusion It seems that mirror change in the ST segment plays a role in the severity of responsible vessel occlusion and the significance of irresponsible vessel occlusion. Mirror change did not affect EF level, though it influenced thrombolytic responses.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Mirror changes in inferior wall myocardial infarction and its relationship with coronary lesions in non-infarcted areas using angiographic and electrocardiographic findings

Faramarzzadeh

Nobakht

Behnemoon

et al. 2023

Preprint

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“…По данным магнитно-резонансной томографии зона некроза ОИМ при хорошо развитой коллатеральной сети значимо меньше (17,1 ± 10,1% ЛЖ), чем при плохо развитой Оригинальные статьи (21,8 ± 10,5% ЛЖ); р = 0,003 [16]. У пациентов с ОИМ с подъемом сегмента ST при развитой коллатеральной сети на ЭКГ отсутствуют реципрокные изменения [17]. Независимыми предикторами развития реципрокных изменений на ЭКГ считают нижний инфаркт (p = 0,024) и ПКА в качестве ИСА (p = 0,034).…”

Section: Discussionunclassified

Biochemical, coronary angiographic and echocardiographic parameters in inferior acute myocardial infarction with right ventricle injury

Vlasova

Акрамова

Sharafutdinov

et al. 2022

Almanac of Clinical Medicine

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Background: The involvement of the right ventricular (RV) myocardium in inferior acute myocardial infarction (AMI) increases the risk of complication and death rates, which makes it important to timely identify this type of myocardial infarction. Aim: To assess the value of functional, biochemical, coronary angiographic and ultrasound parameters in the patients in their productive age with inferior AMI, in order to identify the RV injury before and after percutaneous coronary intervention (PCI). Materials and methods: This cohort prospective study included 141 patients with inferior AMI and ST elevation (26 women aged up to 60 years and 115 men aged up to 65 years), admitted to the emergency of the Medical Unit of Kazan (Volga region) Federal University from 2019 to 2021. The patients past history, clinical, biochemical and ultrasound data were obtained on admission and at discharge from the hospital. The two-dimensional speckle tracking echocardiography was performed at days 5 to 7 after PCI. The results are given as median values and 25% and 75% quartiles (Ме [Q1; Q3]). Results: According to electrocardiographic signs, 41.8% (n = 59) patients with inferior AMI comprised the group with the RV injury. There were no differences in the myocardial injury biomarker levels between the groups on admission (р = 0.31 and p = 0.786, respectively). The coronary angiography showed that the index artery was the right coronary artery in 100% (n = 59) cases with the RV injury and in 67.1% (n = 55, р 0.001) of the cases without the RV injury. Proximal involvement was 2.7 more common in biventricular infarction, than in the isolated inferior one (р = 0.013). During PCI, the RV involvement significantly increased the risk of complications (in 28 (47.5%) and 18 (22.0%) of the cases, respectively, р 0.001), among them being the need in a temporary pacemaker placement (8 (13.6%) and 2 (2.4%) patients, р = 0.027). Echocardiography showed worse parameters of global and local contractility of both ventricles in the group with the RV involvement in the inferior AMI. The left ventricular (LV) ejection fraction decreased from 55% [51; 57] to 52% [47; 56] (р = 0.005); global RV deformity from -15.2% [-18.5; -13.4] to -12.3% [-15.6; -10.6] (р 0.001); total number of segments with local contractility abnormalities increased from 2 [1; 3] to 5 [3; 6] (р 0.001). Conclusion: The study has confirmed that the involvement of RV into inferior LV AMI in the patients of productive age should be verified by abnormalities of electrocardiographic, biochemical, coronary angiographic and ultrasound parameters. To document the RV injury before PCI, ST elevation in additional right chest leads (V3RV4R) was most informative, whereas after PCI, it was the finding of abnormal local contractility of basal and medial inferior RV segments by two-dimensional echocardiography and decreased longitudinal RV deformation by speckle tracking.

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“…Acute ST segment elevation myocardial infarction (STEMI) is often accompanied by ST segment depression in the leads opposite to the leads showing ST segment elevation, known as reciprocal ST segment depression (RSTD), which is seen in either ischemia at distance or mirror reflection of ST segment elevation. [1,2] The RSTD mentioned in this paper refers to mirror reflection of ST segment elevation.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and mechanism of reciprocal ST-segment depression in acute ST segment elevation myocardial infarction: Reciprocal ST-segment depression and ST segment elevation myocardial infarction

Gao

Bie

et al. 2022

Medicine

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At present, the mechanism of reciprocal ST-segment depression (RSTD) is unclear. ST-segment changes may be caused by the potential difference between the positive and negative electrodes, although this requires further investigation. The characteristics of RSTD and their relationship with ST-segment elevation in acute ST segment elevation myocardial infarction (STEMI) patients were analyzed. We replaced the negative electrode of the precordial leads of an inferior wall myocardial infarction patient and observed the changes in the ST-segment of the precordial leads. A total of 85 patients were included, of which 75 were patients with RSTD. All 45 patients with inferior myocardial infarction had limb lead RSTD, and 37 had anterior lead ST-segment depression. All ST-segment changes in STEMI can be explained by the proposed mechanism, and the value of ST segment depression in limb leads can be calculated by the value of ST segment elevation. In summary, the mechanism of RSTD in acute myocardial infarction may be that the action potential (AP) of the negative electrode of the lead weakens or disappears and the AP of the positive electrode may not be completely offset, resulting in ST-segment depression. Animal experimental studies are needed for further confirmation. When the negative electrode of the precordial lead is changed in acute inferior wall myocardial infarction patient, the ST-segment of the precordial lead changes accordingly. All the changes are consistent with our analysis.

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Relation of collateral circulation with reciprocal changes in patients with acute ST-elevation myocardial infarction

Cited by 6 publications

References 28 publications

Mirror changes in inferior wall myocardial infarction and its relationship with coronary lesions in non-infarcted areas using angiographic and electrocardiographic findings

Mirror changes in inferior wall myocardial infarction and its relationship with coronary lesions in non-infarcted areas using angiographic and electrocardiographic findings

Biochemical, coronary angiographic and echocardiographic parameters in inferior acute myocardial infarction with right ventricle injury

Characteristics and mechanism of reciprocal ST-segment depression in acute ST segment elevation myocardial infarction: Reciprocal ST-segment depression and ST segment elevation myocardial infarction

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