Key result
Patients with anterior STEMI and ST-elevation in aVL had more myocardial area at risk >20% at the basal anterior segment compared to those without.
Why the study?
Does the presence of ST-elevation in aVL indicate a different segmental distribution of myocardial area at risk in patients with anterior STEMI?
Observational (n=32)
Does the presence of ST-elevation in aVL indicate a different segmental distribution of myocardial area at risk in patients with anterior STEMI?
Answers are grounded in this paper and cite their sources.
In anterior STEMI, the presence of ST-elevation in aVL is associated with greater area at risk in the basal anterior segment and less in the apical inferior segment.
BACKGROUND: Anterolateral myocardial infarction (MI) is traditionally defined on the electrocardiogram by ST-elevation (STE) in I, aVL, and the precordial leads. Traditional literature holds STE in lead aVL to be associated with occlusion proximal to the first diagonal branch of the left anterior descending coronary artery. However, concomitant ischemia of the inferior myocardium may theoretically lead to attenuation of STE in aVL. We compared segmental distribution of myocardial area at risk (MaR) in patients with and without STE in aVL. Patients underwent cardiac magnetic resonance imaging 3-5 days after acute infarction for quantitative assessment of MaR. RESULTS: A total of 32 patients met inclusion criteria; 13 patients with and 19 without STE in lead aVL. MaR > 20% at the basal anterior segment was seen in 54% of patients with aVL STE, and 11% of those without (p = 0.011). MaR > 20% at the apical inferior segment was seen in 62% and 95% of patients with and without aVL STE, respectively (p = 0.029). The total MaR was not different between groups (44% ± 10% and 39% ± 8.3% respectively, p = 0.15). CONCLUSION: Patients with anterior STEMI and concomitant STE in aVL have less MaR in the apical inferior segment and more MaR in the basal anterior segment.
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Allencherril et al. (2018) conducted an observational in Anterolateral myocardial infarction (n=32). ST-elevation in lead aVL vs. No ST-elevation in lead aVL was evaluated on Myocardial area at risk (MaR) > 20% at the basal anterior segment (p=0.011). Patients with anterior STEMI and ST-elevation in aVL had more myocardial area at risk >20% at the basal anterior segment compared to those without.
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