Key result
In emergency department chest pain patients with left ventricular hypertrophy, a positive baseline ST-vector magnitude or 2-hour QRS-vector difference was associated with a 3.8-fold increased odds of 30-day adverse outcomes.
Why the study?
Does continuous vectorcardiographic monitoring predict 30-day adverse outcomes in emergency department chest pain patients with left ventricular hypertrophy on the initial 12-lead ECG?
Observational (n=196)
No
Does continuous vectorcardiographic monitoring predict 30-day adverse outcomes in emergency department chest pain patients with left ventricular hypertrophy on the initial 12-lead ECG?
Baseline ST-vector magnitude and 2-hour QRS-vector difference can help risk stratify emergency department chest pain patients with left ventricular hypertrophy on the initial ECG for 30-day adverse outcomes.
May support vectorcardiographic risk stratification in LVH chest pain patients; hypothesis-generating and requires prospective validation.
BACKGROUND: Vectorcardiographic (VCG) measurements of ST-vector magnitude (VM) and QRS-vector difference (VD) have been demonstrated to be independent predictors of adverse outcome (AO) and acute myocardial infarction (AMI) in emergency department (ED) chest pain patients with absence of bundle branch block or left ventricular hypertrophy (LVH) on the initial 12-lead electrocardiogram (ECG). The prognostic value of ST-VM and QRS-VD in ED chest pain patients with LVH on the initial 12-lead ECG has not been previously investigated. METHODS: A prospective observational study was performed in 196 consecutive ED chest pain patients with suspected AMI and presence of voltage criteria for LVH on initial ECG who underwent continuous VCG monitoring during the initial evaluation. The optimal baseline ST-VM value and 2-hour QRS-VD value were defined as the most accurate value on the receiver operator characteristic curve (value with lowest false-negative and false-positive rate). Thirty-day AO was defined as AMI, percutaneous coronary intervention, coronary artery bypass grafting (CABG), or cardiac death occurring within 30 days of initial ED visit. RESULTS: Fourteen patients (7.1%) were diagnosed as 24-hour AMI and 28 patients (14.3%) experienced 30-day AO. The optimal cut-off value for predicting 30-day AO was > 124 microV for ST-VM and > 21.7 microV for QRS-VD. Patients with either a positive ST-VM or a positive QRS-VD had 8.8 times increased odds of AMI (95% confidence interval, CI, 1.9-40.3; P = 0.003); 4.3 times increased odds of 30-day PTCA/CABG (95% CI 1.3-13.8; P = 0.019); and 3.8 times increased odds of 30-day AO (95% CI 1.6-9.3; P = 0.003). CONCLUSIONS: Baseline ST-VM and 2-hour QRS-VD risk stratifies ED chest pain patients with LVH voltage criteria on the initial 12-lead ECG.
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Fesmire et al. (2004) conducted an observational in Suspected acute myocardial infarction with left ventricular hypertrophy (n=196). Positive baseline ST-vector magnitude (> 124 µV) or positive 2-hour QRS-vector difference (> 21.7 µV) vs. Negative ST-vector magnitude and QRS-vector difference was evaluated on 30-day adverse outcome (AMI, PCI, CABG, or cardiac death) (OR 3.8, 95% CI 1.6-9.3, p=0.003). In emergency department chest pain patients with left ventricular hypertrophy, a positive baseline ST-vector magnitude or 2-hour QRS-vector difference was associated with a 3.8-fold increased odds of 30-day adverse outcomes.
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