Regional QT Interval Dispersion as an Early Predictor of Reperfusion in Patients with Acute Myocardial Infarction after Fibrinolytic Therapy
Abstract Background: Patients with ST-elevation acute myocardial infarction attending primary care centers, treated with pharmaco-invasive strategy, are submitted to coronary angiography within 2-24 hours of fibrinolytic treatment. In this context, the knowledge about biomarkers of reperfusion, suc...
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| Format: | Article |
| Language: | English |
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Sociedade Brasileira de Cardiologia (SBC)
2018-12-01
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| Series: | Arquivos Brasileiros de Cardiologia |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2018005019101&lng=en&tlng=en |
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| author | Gabriel Dotta Francisco Antonio Helfenstein Fonseca Maria Cristina de Oliveira Izar Marco Tulio de Souza Flavio Tocci Moreira Luiz Fernando Muniz Pinheiro Adriano Henrique Pereira Barbosa Adriano Mendes Caixeta Rui Manoel Santos Póvoa Antônio Carlos Carvalho Henrique Tria Bianco |
| author_facet | Gabriel Dotta Francisco Antonio Helfenstein Fonseca Maria Cristina de Oliveira Izar Marco Tulio de Souza Flavio Tocci Moreira Luiz Fernando Muniz Pinheiro Adriano Henrique Pereira Barbosa Adriano Mendes Caixeta Rui Manoel Santos Póvoa Antônio Carlos Carvalho Henrique Tria Bianco |
| author_sort | Gabriel Dotta |
| collection | DOAJ |
| description | Abstract Background: Patients with ST-elevation acute myocardial infarction attending primary care centers, treated with pharmaco-invasive strategy, are submitted to coronary angiography within 2-24 hours of fibrinolytic treatment. In this context, the knowledge about biomarkers of reperfusion, such as 50% ST-segment resolution is crucial. Objective: To evaluate the performance of QT interval dispersion in addition to other classical criteria, as an early marker of reperfusion after thrombolytic therapy. Methods: Observational study including 104 patients treated with tenecteplase (TNK), referred for a tertiary hospital. Electrocardiographic analysis consisted of measurements of the QT interval and QT dispersion in the 12 leads or in the ST-segment elevation area prior to and 60 minutes after TNK administration. All patients underwent angiography, with determination of TIMI flow and Blush grade in the culprit artery. P-values < 0.05 were considered statistically significant. Results: We found an increase in regional dispersion of the QT interval, corrected for heart rate (regional QTcD) 60 minutes after thrombolysis (p = 0.06) in anterior wall infarction in patients with TIMI flow 3 and Blush grade 3 [T3B3(+)]. When regional QTcD was added to the electrocardiographic criteria for reperfusion (i.e., > 50% ST-segment resolution), the area under the curve increased to 0.87 [(0.78-0.96). 95% IC. p < 0.001] in patients with coronary flow of T3B3(+). In patients with ST-segment resolution >50% and regional QTcD > 13 ms, we found a 93% sensitivity and 71% specificity for reperfusion in T3B3(+), and 6% of patients with successful reperfusion were reclassified. Conclusion: Our data suggest that regional QTcD is a promising non-invasive instrument for detection of reperfusion in the culprit artery 60 minutes after thrombolysis. |
| first_indexed | 2024-12-19T19:34:06Z |
| format | Article |
| id | doaj.art-ebc359e14693499b9e35b96cb0755971 |
| institution | Directory Open Access Journal |
| issn | 1678-4170 |
| language | English |
| last_indexed | 2024-12-19T19:34:06Z |
| publishDate | 2018-12-01 |
| publisher | Sociedade Brasileira de Cardiologia (SBC) |
| record_format | Article |
| series | Arquivos Brasileiros de Cardiologia |
| spelling | doaj.art-ebc359e14693499b9e35b96cb07559712022-12-21T20:08:32ZengSociedade Brasileira de Cardiologia (SBC)Arquivos Brasileiros de Cardiologia1678-41702018-12-01010.5935/abc.20180239S0066-782X2018005019101Regional QT Interval Dispersion as an Early Predictor of Reperfusion in Patients with Acute Myocardial Infarction after Fibrinolytic TherapyGabriel DottaFrancisco Antonio Helfenstein FonsecaMaria Cristina de Oliveira IzarMarco Tulio de SouzaFlavio Tocci MoreiraLuiz Fernando Muniz PinheiroAdriano Henrique Pereira BarbosaAdriano Mendes CaixetaRui Manoel Santos PóvoaAntônio Carlos CarvalhoHenrique Tria BiancoAbstract Background: Patients with ST-elevation acute myocardial infarction attending primary care centers, treated with pharmaco-invasive strategy, are submitted to coronary angiography within 2-24 hours of fibrinolytic treatment. In this context, the knowledge about biomarkers of reperfusion, such as 50% ST-segment resolution is crucial. Objective: To evaluate the performance of QT interval dispersion in addition to other classical criteria, as an early marker of reperfusion after thrombolytic therapy. Methods: Observational study including 104 patients treated with tenecteplase (TNK), referred for a tertiary hospital. Electrocardiographic analysis consisted of measurements of the QT interval and QT dispersion in the 12 leads or in the ST-segment elevation area prior to and 60 minutes after TNK administration. All patients underwent angiography, with determination of TIMI flow and Blush grade in the culprit artery. P-values < 0.05 were considered statistically significant. Results: We found an increase in regional dispersion of the QT interval, corrected for heart rate (regional QTcD) 60 minutes after thrombolysis (p = 0.06) in anterior wall infarction in patients with TIMI flow 3 and Blush grade 3 [T3B3(+)]. When regional QTcD was added to the electrocardiographic criteria for reperfusion (i.e., > 50% ST-segment resolution), the area under the curve increased to 0.87 [(0.78-0.96). 95% IC. p < 0.001] in patients with coronary flow of T3B3(+). In patients with ST-segment resolution >50% and regional QTcD > 13 ms, we found a 93% sensitivity and 71% specificity for reperfusion in T3B3(+), and 6% of patients with successful reperfusion were reclassified. Conclusion: Our data suggest that regional QTcD is a promising non-invasive instrument for detection of reperfusion in the culprit artery 60 minutes after thrombolysis.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2018005019101&lng=en&tlng=enInfarto do Miocárdio com Supradesnível do Segmento STEletrocardiografiaReperfusão MiocárdicaIntervenção Coronária PercutâneaBiomarcadores |
| spellingShingle | Gabriel Dotta Francisco Antonio Helfenstein Fonseca Maria Cristina de Oliveira Izar Marco Tulio de Souza Flavio Tocci Moreira Luiz Fernando Muniz Pinheiro Adriano Henrique Pereira Barbosa Adriano Mendes Caixeta Rui Manoel Santos Póvoa Antônio Carlos Carvalho Henrique Tria Bianco Regional QT Interval Dispersion as an Early Predictor of Reperfusion in Patients with Acute Myocardial Infarction after Fibrinolytic Therapy Arquivos Brasileiros de Cardiologia Infarto do Miocárdio com Supradesnível do Segmento ST Eletrocardiografia Reperfusão Miocárdica Intervenção Coronária Percutânea Biomarcadores |
| title | Regional QT Interval Dispersion as an Early Predictor of Reperfusion in Patients with Acute Myocardial Infarction after Fibrinolytic Therapy |
| title_full | Regional QT Interval Dispersion as an Early Predictor of Reperfusion in Patients with Acute Myocardial Infarction after Fibrinolytic Therapy |
| title_fullStr | Regional QT Interval Dispersion as an Early Predictor of Reperfusion in Patients with Acute Myocardial Infarction after Fibrinolytic Therapy |
| title_full_unstemmed | Regional QT Interval Dispersion as an Early Predictor of Reperfusion in Patients with Acute Myocardial Infarction after Fibrinolytic Therapy |
| title_short | Regional QT Interval Dispersion as an Early Predictor of Reperfusion in Patients with Acute Myocardial Infarction after Fibrinolytic Therapy |
| title_sort | regional qt interval dispersion as an early predictor of reperfusion in patients with acute myocardial infarction after fibrinolytic therapy |
| topic | Infarto do Miocárdio com Supradesnível do Segmento ST Eletrocardiografia Reperfusão Miocárdica Intervenção Coronária Percutânea Biomarcadores |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2018005019101&lng=en&tlng=en |
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