Key result
In patients with acute NSTEMI, the relative reduction of QT dispersion on surface ECG prior to and post PCI independently predicted non-transmural infarcts (OR 1.110).
Why the study?
Does the relative reduction of QT dispersion (QTD-Rrel) on ECG predict infarct size and transmurality in patients with a first acute NSTEMI undergoing PCI?
Observational (n=69)
No
Does the relative reduction of QT dispersion (QTD-Rrel) on ECG predict infarct size and transmurality in patients with a first acute NSTEMI undergoing PCI?
Odds Ratio: 1.11 (95% CI 1.055–1.167)
p-value: p=0.049
The relative reduction of QT dispersion on surface ECG before and after PCI for NSTEMI serves as a non-invasive marker that correlates with smaller, non-transmural infarcts on CMR.
QTD reduction may support non-invasive assessment of non-transmural NSTEMI infarcts; hypothesis-generating and requires prospective validation before clinical use.
BACKGROUND/OBJECTIVES: Non-ST segment elevation myocardial infarction (MI) poses similar detrimental long-term prognosis as ST-segment elevation MI. No marker on ECG is established to predict successful reperfusion in NSTEMI. QT dispersion is increased by myocardial ischemia and reduced by successful restoration of epicardial blood flow by PCI. Whether QT dispersion reduction translates to smaller infarcts and thus indicates successful reperfusion is unknown. We hypothesized that the relative reduction of QT dispersion (QTD-Rrel ) on a standard ECG in acutely reperfused NSTEMI is related to infarct size and infarct transmurality as assessed by delayed enhancement CMR (DE-CMR). METHODS AND RESULTS: 69 patients with a first acute NSTEMI were included. QTD-Rrel was stratified according to LV function and volumes, infarct transmurality and size as assessed by DE-CMR. Extensive myocardial infarction was defined as above median infarct size. LV function and end-systolic volume were only mildly related to QTD-Rrel . QTD-Rrel was inversely related to infarct size (r=-0.506,p=0.001) and infarct transmurality (r=-0.415, p=0.001). QTD-Rrel was associated with extensive myocardial infarction in univariate analysis (odds ratio (OR) 0.958, CI 0.935-0.982; p=0.001). Compared to clinical and angiographic data QTD-Rrel remained the only independent predictor of non-transmural infarcts (OR 1.110, CI 1.055-1.167; p=0.049). CONCLUSION: In patients with acute Non-ST-Segment Myocardial infarction QTd-Rrel calculated on a surface ECG prior and post PCI for restoration of epicardial blood flow detects small, non-transmural infarcts as assessed by delayed enhancement CMR. Thus, QTd-Rrel can indicate successful reperfusion therapy.
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Jensen et al. (2015) conducted an observational in Non-ST segment elevation myocardial infarction (NSTEMI) (n=69). Relative reduction of QT dispersion (QTD-Rrel) vs. Clinical and angiographic data was evaluated on Non-transmural infarcts (OR 1.110, 95% CI 1.055-1.167, p=0.049). In patients with acute NSTEMI, the relative reduction of QT dispersion on surface ECG prior to and post PCI independently predicted non-transmural infarcts (OR 1.110).
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