Pathological Q wave as an indicator of left ventricular ejection fraction in acute myocardial infarction

Authors

  • Muhammad S. Tiyantara Faculty of Medicine, Universitas Mulawarman, Samarinda
  • Muhammad Furqon Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Mulawarman, Samarinda
  • Swandari Paramita Laboratory of Public Health, Faculty of Medicine, Universitas Mulawaman, Samarinda

DOI:

https://doi.org/10.13181/mji.v25i2.1274

Keywords:

LVEF, non-Q-wave myocardial infarction, pathological Q wave, Q-wave myocardial infarction

Abstract

Background: Q-wave myocardial infarction (QMI) has higher mortality and lower myocardial viability than non-Q-wave myocardial infarction (NQMI), suggesting the existence of pathological Q waves reflects the worse ventricular function. The aim of the study is to determine difference in left ventricular ejection fraction (LVEF) between QMI and NQMI.

Methods: The study design was cross-sectional analysis conducted in patients with AMI that were hospitalized and undergone echocardiography in Abdul Wahab Sjahranie County General Hospital Samarinda during February 2014 to March 2015. Standard 12-lead electrocardiograms (ECG) were recorded at presentation, 1 day and 2 days after the onset of AMI as well as using the classical criteria for pathological Q wave. LVEF assessment was performed using echocardiography after the second day since the onset of AMI. Independent-T test was used to determine difference in LVEF using PSPPIRE 0.8.4.

Results: There were 34 subjects comprising 16 QMI patients and 18 NQMI patients. QMI had a lower LVEF (42±13%) compared to NQMI (60±11%, p<0.001). The presence of pathological Q waves was associated with LVEF ≤40% (p=0.002).

Conclusion: QMI had a lower LVEF than NQMI, provides information about the role of pathological Q wave as an indicator of LVEF.

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Author Biographies

Muhammad S. Tiyantara, Faculty of Medicine, Universitas Mulawarman, Samarinda

Medical Student, Faculty of Medicine, Universitas Mulawarman, Samarinda, Indonesia

Muhammad Furqon, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Mulawarman, Samarinda

Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Mulawarman, Samarinda, Indonesia

Swandari Paramita, Laboratory of Public Health, Faculty of Medicine, Universitas Mulawaman, Samarinda

Laboratory of Public Health, Faculty of Medicine, Universitas Mulawaman, Samarinda, Indonesia

References

Velasco M, Rojas ER. Non-Q-wave myocardial infarction: comprehensive analysis of electrocardiogram and pathological correlation. Síndrome Cardiometabólico. 2011; 1(1):4-10. doi: 10.1097/MJT.0b013e3182459bf5

Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, et al. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/nonâ??ST-elevation myocardial infarction. Circulation. 2013;127:663-828. http://dx.doi.org/10.1161/CIR.0b013e31828478ac

Jeon HK, Shah GA, Diwan A, Cwajg JM, Park TH, McCulloch ML, et al. Lack of pathologic Q waves: a specific marker of viability in myocardial hibernation. Clin Cardiol. 2008;31(8):372â??7. http://dx.doi.org/10.1002/clc.20244

Ananthasubramaniam K, Chow BJ, Ruddy TD, deKemp R, Davies RA, DaSilva J, et al. Does electrocardiographic Q wave burden predict the extent of scarring or hibernating myocardium as quantified by positron emission tomography? Can J Cardiol. 2005;21(1):51-6.

Halkin A, Fourey D, Roth A, Boyko V, Behar S. Incidence and prognosis of non-Q-wave vs. Q-wave myocardial infarction following catheter-based reperfusion therapy. QJM. 2009;102(6):401-6. http://dx.doi.org/10.1093/qjmed/hcp037

Armstrong PW, Fu Y, Westerhout CM, Hudson MP, Mahaffey KW, White HD, et al. Baseline Q-wave surpasses time from symptom onset as a prognostic marker in ST-segment elevation myocardial infarction patient treated with primary percutaneous coronary intervention. J Am Coll Cardiol. 2009;53(17):1503-9. http://dx.doi.org/10.1016/j.jacc.2009.01.046

Siha H, Das D, Fu Y, Zheng Y, Westerhout CM, Storey RF, et al. Baseline Q waves as a prognostic modulator in patients with ST-segment elevation: insight from the PLATO trial. CMAJ. 2012;184(10):1135-42. http://dx.doi.org/10.1503/cmaj.111683

Bonow, Mann, Zipes, Libby. Braunwald's heart disease: a textbook of cardiovascular medicine. 10th ed. Philadelphia: Elsevier; 2015.

Camm AJ, Lüscher TF, Serruys PW. The ESC textbook of cardiovascular medicine. 2nd ed. Oxford: Blackwell Publishing; 2006.

Sztajzel J, Urban P. Early and late Q wave regression in the setting of acute myocardial infarction. Heart. 2000;83(6):708-10. http://dx.doi.org/10.1136/heart.83.6.708

Voon WC, Chen YW, Hsu CC, Lai WT, Sheu SH. Q-wave regression after acute myocardial infarction assessed by Tl-201 myocardial perfusion SPECT. J Nucl Cardiol. 2004;11(2):165-70. http://dx.doi.org/10.1016/j.nuclcard.2003.10.009

Kelly RF, Sluiter W, McFalls EO. Hibernating myocardium: is the program to survive a pathway to failure? Circ Res. 2008;102(1):3-5. http://dx.doi.org/10.1161/CIRCRESAHA.107.168278

Heusch G, Schulz R, Rahimtoola SH. Myocardial hibernation: a delicate balance. Am J Physiol Heart Circ Physiol. 2005;288(3):984-99. http://dx.doi.org/10.1152/ajpheart.01109.2004

Kloner RA, Bolli R, Marban E, Reinlib L, Braunwald E. Medical and cellular implications of stunning, hibernation, and preconditioning: an NHLBI workshop. Circulation. 1998;97(18):1848-67. http://dx.doi.org/10.1161/01.CIR.97.18.1848

Tao ZW, Huang YW, Xia Q, Fu J, Zhao ZH, Lu X, et al. Early association of electrocardiogram alteration with infarct size and cardiac function after myocardial infarction. J Zhejiang Univ Sci. 2004;5(4):494-8. http://dx.doi.org/10.1631/jzus.2004.0494

Pride YB, Giuseffi JL, Mohanavelu S, Harrigan CJ, Manning WJ, Gibson CM, et al. Relation between infarct size in ST-segment elevation myocardial infarction treated successfully by percutaneous coronary intervention and left ventricular ejection fraction three months after the infarct. Am J Cardiol. 2010;106(5):635-40. http://dx.doi.org/10.1016/j.amjcard.2010.04.012

Delewi R, Ijff G, van de Hoef TP, Hirsch A, Robbers LF, Nijveldt R, et al. Pathological Q waves in myocardial infarction in patients treated by primary PCI. JACC Cardiovasc Imaging. 2013;6(3):324-31. http://dx.doi.org/10.1016/j.jcmg.2012.08.018

Yang H, Pu M, Rodriguez D, Underwood D, Griffin BP, Kalahasti V, et al. Ischemic and viable myocardium in patients with nonâ??Q-wave or Q-wave myocardial infarction and left ventricular dysfunction: a clinical study using positron emission tomography, echocardiography, and electrocardiography. J Am Coll Cardiol. 2004;43(4):592-8. http://dx.doi.org/10.1016/j.jacc.2003.07.052

Plein S, Younger J, Sparrow P, Ridgway J, Ball SG, Greenwood JP. Cardiovascular magnetic resonance of scar and ischemia burden early after acute ST elevation and non-ST elevation myocardial infarction. J Cardiovasc Magn Reson. 2008;10:47. http://dx.doi.org/10.1186/1532-429X-10-47

Moon JC, Arenaza DP, Elkington AG, Taneja AK, John AS, Wang D, et al. The pathologic basis of Q-wave and non-Q-wave myocardial infarction. J Am Coll Cardiol. 2004;44(3):554-60. http://dx.doi.org/10.1016/j.jacc.2004.03.076

Cacciapuoti F. Echocardiographic evaluation of ejection fraction: 3DE versus 2DE and M-Mode. Heart Views. 2008;9(2):71-9.

Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, et al. American Society of Echocardiography recomendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr. 2004;17(10):1086-119. DOI: 10.1016/j.echo.2004.07.013

Published

2016-07-26

How to Cite

1.
Tiyantara MS, Furqon M, Paramita S. Pathological Q wave as an indicator of left ventricular ejection fraction in acute myocardial infarction. Med J Indones [Internet]. 2016Jul.26 [cited 2024Nov.22];25(2):98-103. Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/1274

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Section

Clinical Research
Abstract viewed = 1752 times

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