Abnormal ST-segment changes in anterior and inferior leads during acute inferior myocardial infarction.

Anterior and inferior ST elevation on electrocardiography (ECG) in patients with acute myocardial infarction is uncommon. ST-segment elevation due to right ventricular infarction induced by right coronary occlusion may extend from V1 to V3/V4, resembling the pattern of transmural ischemia of the anterior wall of the left ventricle. In addition, a wraparound left anterior descending (LAD) artery can produce ischemia manifesting as ST-segment elevation in the anterior and inferior leads. Our case report reveals dynamic ST-segment changes in acute inferior myocardial infarction, including the appearance of the shark fin ECG pattern, unlike what has been reported before.

Yang S ，Wang C ，Zhang H ，Wang J ... -  《-》

Electrocardiographic findings for predicting the left anterior descending artery chronic total occlusion in patients with inferior ST-segment elevation myocardial infarction.

In determining the culprit vessel responsible for inferior ST-segment elevation myocardial infarction (STEMI) as either the right coronary artery (RCA) or left circumflex (LCX), the electrocardiographic value has been validated. However, its ability to predict whether inferior STEMI is complicated by left anterior descending artery (LAD) chronic total occlusion remains uncertain. Based on the involvement of arteries other than the culprit vessels, 189 patients with inferior STEMI from our chest pain center were categorized into four groups: LAD occlusion group (n = 20), LAD stenosis > 50% group (n = 116), normal LAD group (n = 27), and other vessel stenosis > 50% group (n = 26). All groups underwent coronary angiography within 24 h of admission, and electrocardiogram (ECG) and clinical data were retrospectively analyzed. In the LAD occlusion group, hypertension was significantly more prevalent (P = 0.015). Although there was a trend toward higher previous cerebral infarction and lower diabetes prevalence in the Normal LAD group, neither was statistically significant (P = 0.070 and P = 0.088). The LAD occlusion group demonstrated the highest serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and the most reduced LVEF, with a higher susceptibility to cardiogenic shock (P < 0.01). This group also had a higher use of intra-aortic balloon pump (IABP) and a greater occurrence of ventricular fibrillation or tachycardia compared to the other groups (P < 0.05). The QRS duration in lead V4 (QRS V4) was 99.4 ± 19.1 ms in the LAD occlusion group, 87.5 ± 14.9 ms in the LAD stenosis group, 89.6 ± 11.4 ms in the normal LAD group, and 87.7 ± 11.7 ms in the other vessel stenosis group (P = 0.010). The difference between ST-segment depression in V4 and ST-segment elevation in lead III (ST V4↓- ST III↑) in the LAD occlusion group was the largest at -0.06 (-1.19, 1.05) mm (P = 0.029). ROC curve analysis revealed that the sensitivity of QRS V4 > 97.7ms and ST V4↓- ST III↑> 0 mm diagnosing inferior STEMI complicated with LAD occlusion was 54.5% and 50%, with a specificity of 75.1% and 78.0%, respectively. Multivariate logistic regression analysis indicated that QRS V4 (OR = 1.062, P = 0.003), ST V4↓- ST III↑ (OR = 1.641, P = 0.050), and Killip classification (OR = 2.115, P = 0.004) were all independent risk factors for LAD occlusion. In patients with inferior STEMI complicated by LAD occlusion without anterior myocardial infarction, cardiac function is poorer. The ST-segment deviation between the leads V4 and III, and the duration of QRS in the lead V4, can aid in diagnosis.

Zheng X ，Zhang Z ，Yao B ，Wu H ... -  《Scientific Reports》

The Relationship Between the Type of ST-Segment Elevation in Acute Anterior Wall Myocardial Infarction and Left Ventricular Ejection Function.

Acute anterior wall myocardial infarction (AWMI), when presenting with ST-segment elevation on an electrocardiogram (ECG), represents a form of ST-elevation myocardial infarction (STEMI) caused by a significant reduction in coronary blood flow to the heart muscle. The shape of the ST-segment elevation, whether it is concave, convex, or straight, has been associated with different levels of left ventricular ejection fraction (LVEF), which is an important indicator of cardiac function and prognosis. To investigate the relationship between the type of ST-segment elevation on ECG and LVEF measured 48 hours after the onset of myocardial infarction in patients with AWMI. A retrospective observational study was conducted on 317 patients with acute anterior wall myocardial infarction at Shalamar Hospital, Lahore, Pakistan, from January 2023 to December 2023. Patients' electrocardiograms were analyzed for ST-segment elevation morphology, and left ventricular ejection fraction was assessed using echocardiography. Long-term echocardiography was performed at 30 days and 90 days post-infarction to evaluate the long-term effects on LVEF and to assess for stunned or hibernating myocardium. Statistical analysis was performed in IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. to determine the association between ST-segment types and left ventricular ejection fraction. The mean age was 58.3 ± 12.4 years, with a majority being male (67.5%). Key findings included that 33.1% of patients had left ventricular ejection fraction (LVEF) < 40%, while the mean LVEF was 45.2 ± 9.8%. Primary percutaneous coronary intervention (PCI) was performed in 45.7% of patients, and no deaths occurred during hospitalization. A significant association was observed between the type of ST-segment elevation and LVEF, with convex ST elevation linked to a 2.7-fold increased likelihood of severe LV dysfunction (LVEF < 40%) and a hazard ratio of 2.3 for adverse outcomes (p = 0.005). In contrast, concave ST elevation did not show significant predictive value for LV dysfunction. Older age and smoking were also identified as strong predictors of LV dysfunction, highlighting the impact of these factors on patient outcomes post-AWMI. The study demonstrates a significant correlation between convex ST-segment elevation and lower LVEF, suggesting that ST-segment morphology can serve as an important prognostic indicator in AWMI patients.

Ahmad F ，Tariq S ，Mumtaz MH ，Saleem M ，Arif MA ，Arif Butt MZ ，Qammar B ，Mansoor MH ，Ahmad M ，Ali H ... -  《Cureus》

Aslanger's pattern with acute lesion in the left coronary system: A case report.

Agnese MAVD ，Copetti AS ，de Ferreira Filho SF ，de Ferreira PR ，Leiria TLL ... -  《-》

Anterior Myocardial Infarction.

Bansal K ，Gore M ，Afzal M ，Shams P ，Nalabothu P ... -  《-》