Editorial
Volume 7 Issue 2 - 2020
Diagnosis, Management, and Prognosis of Myocardial Infarction (MI)
Osmar Antonio Centurión1,2*, José Fernando Alderete1,2 and José Carlos Candia1,2
1Department of Health Sciences Investigation, Sanatorio Metropolitano, Fernando de la Mora, Paraguay
2Cardiology Department, First Department of Internal Medicine, Clinic Hospital, Asunción National University, San Lorenzo, Paraguay
*Corresponding Author: Osmar Antonio Centurión, Professor of Medicine, Department of Health Sciences Investigation, Asuncion National University, Sanatorio Metropolitano, Fernando de la Mora, Paraguay.
Received: December 23, 2019; Published: January 09, 2020




Abstract

There is no doubt that there have been major advances in the diagnostic and therapeutic management of cardiovascular diseases. However, ischemic heart disease (IHD) continues to be the leading cause of mortality and morbidity worldwide. IHD affects nearly 16 million persons aged 20 years and older in the USA. Nearly 4 million cases of acute myocardial infarction (AMI) occur annually in the world. These numbers will likely increase over the next decade due to advancing age [1,2]. The prevalence of patients who have survived an episode of AMI is estimated at 15 million, these patients are at high risk to develop additional episodes of acute coronary syndromes. Malignant ventricular arrhythmias are the more prevailing cause of sudden cardiac death in patients with IHD [3]. It is estimated that up to 20% of patients with AMI develop these ventricular arrhythmias [4]. Therefore, there is an increasing necessity to develop adequate tools for risk assessment for SCD in this set of patients with IHD. Several ECG indices have been proposed for risk stratification and prognosis in patients with AMI [5,6].

Several clinical studies have focused on the electrophysiological characterization of arrhythmogenic substrates in the myocardium of AMI patients to try to predict malignant arrhythmias and sudden cardiac death (SCD) [7-9]. Some researchers have focused on the QRS complex, QT interval, and T-wave alternans as an index for predicting fatal ventricular arrhythmias [8]. The interval from the peak to the end the T wave (Tpeak-Tend interval) has been also proposed for the prediction of malignant arrhythmias and SCD in some entities [9]. Previous experimental animal studies have indicated that the Tpeak-Tend interval in the electrocardiogram measured across the wedge correlates well with the transmural dispersion of cellular repolarization and, may serve as an index of total dispersion of transmural global repolarization [10]. The Tpeak-Tend/QT ratio is another good index of ventricular repolarization that remains constant despite differences in body mass index or dynamic changes in heart rate. It provides a valuable consistency and permits longitudinal comparison of results. It has a better sensitivity for arrhythmogenesis compared to the lone utilization of either the Tpeak-Tend or QT intervals [11].

References

  1. Reynolds K., et al. “Trends in Incidence of Hospitalized Acute Myocardial Infarction in the Cardiovascular Research Network (CVRN)”. The American Journal of Medicine 130.3 (2017): 317-327. 
  2. Braunwald E., et al. “Rationale and Clinical evidence for the use of GP IIb/IIIa inhibitors in acute coronary syndromes”. European Heart Journal 19 (1998): D22-D30.
  3. Cannon CP and Greenberg BH. “Risk stratification and prognostic factors in the post- myocardial infarction patient”. The American Journal of Cardiology 102 (2008): 13G-20G.
  4. Huikuri HV., et al. “Prediction of fatal or near- fatal cardiac arrhythmia events in patients with depressed left ventricular function after an acute myocardial infarction”. European Heart Journal 30 (2009): 689-698.
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  6. Goldenberg I., et al. “Corrected QT variability in serial electrocardiograms in long QT syndrome: the importance of the maximum corrected QT for risk stratification”. Journal of the American College of Cardiology 48 (2006): 1047-1052.
  7. Tse G and Yan BP. “Traditional and novel electrocardiographic conduction and repolarization markers of sudden cardiac death”. Europace 19 (2017): 712-721.
  8. Gimeno-Blanes FJ., et al. “Sudden cardiac risk stratification with electrocardiographic indices––a review on computational processing, technology transfer, and scientific evidence”. Frontiers in Physiology 7 (2016): 82.
  9. Abdelghani SA., et al. “Surface electrocardiogram predictors of sudden cardiac arrest”. Ochsner Journal 16 (2016): 280-289.
  10. Antzelevitch C., et al. “Does Tpeak-Tend provide an index of transmural dispersion of repolarization?” Heart Rhythm 4 (2007): 1114-1116.
  11. Gupta P., et al. “Tp-e/QT ratio as an index of arrhythmogenesis”. Journal of Electrocardiology 41 (2008): 567-574.
  12. Shu J., et al. “Tp-e/QT ratio as a predictive index of sudden cardiac death in patients with ST-segment elevation myocardial infarction”. Journal of Xi'an Jiaotong University Medical Sciences 31 (2010): 441-443.
  13. Zhao X., et al. “Association Between Tp-e/QT Ratio and Prognosis in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction”. Clinical Cardiology 35.9 (2012): 559-564.
  14. Yan GX., et al. “Phase 2 reentry as a trigger to initiate ventricular fibrillation during early acute myocardial ischemia”. Circulation 110 (2004): 1036-1041.
  15. Wang X., et al. “Tpeak-Tend/QT interval predicts ST- segment resolution and major adverse cardiac events in acute ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention”. Medicine 97.43 (2018): e12943. 
  16. Gupta P., et al. “T(p-e)/QT ratio as an index of arrhythmogenesis”. Journal of Electrocardiology 41 (2008): 567-574.
  17. Hetland M., et al. “A novel ECG-index for prediction of ventricular arrhythmias in patients after myocardial infarction”. Annals of Noninvasive Electrocardiology 19 (2014): 330-337.
  18. Järvenpää J., et al. “Changing capacity of electrocardiographic ventricular repolarization in postmyocardial infarction patients with and without nonfatal cardiac arrest”. The American Journal of Cardiology 99 (2007): 295-299.
  19. Zabel M., et al. “Assessment of QT dispersion for prediction of mortality or arr hythmic events after myocardial infarction: results of a prospective, long-term follow-up study”. Circulation 97 (1998): 2543-2550.
  20. Tse G., et al. “Meta-analysis of T- wave indices for risk stratification in myocardial infarction”. Journal of Geriatric Cardiology 14 (2017): 776-779.
Citation: Osmar Antonio Centurión., et al. “12-Leads Conventional Electrocardiographic Repolarization Indices Associated to Prognosis in Acute Myocardial Infarction”. EC Cardiology 7.2 (2020): 01-03.

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