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


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].


  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.
  5. Kuriachan V and Exner DV. “Role of risk stratification after myocardial infarction”. Current Treatment Options in Cardiovascular Medicine 11 (2009): 10-21.
  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.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

December Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 21, 2022.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.