TY - JOUR
T1 - Reciprocal ST change in acute myocardial infarction
T2 - Assessment by electrocardiography and echocardiography
AU - Camara, Edmundo J.N.
AU - Chandra, Nisha
AU - Ouyang, Pamela
AU - Gottlieb, Sheldon H.
AU - Shapiro, Edward P.
N1 - Funding Information:
From the Division of Cardiology, Baltunore City Hospitals and the Johns Hopkins University School of Medicine, Baltimore, Maryland This study was supported in part by Chesapeake Physicians, P.A., Baltimore, Maryland, and CAPES, Post-Graduate Educational Federal Agency, Brasilia, Brazil. Manuscript received January 18, 1983; revised manuscript received March 28,1983, accepted Apnl I, 1983. Address for reprints: Edward P. Shapiro, MD, Drvision of Cardiology, Baltimore City Hospitals, 4940 Eastern Avenue, Baltimore, Maryland 21224.
PY - 1983
Y1 - 1983
N2 - To evaluate the incidence, time course and significance of reciprocal change, 25 consecutive patients admitted with their first acute transmural myocardial infarction were studied with serial electrocardiography and two-dimensional echocardiography. Reciprocal change was noted in all patients with inferior infarction (mean maximal ST segment depression 3.53 ± 1.97 mm) and 70% of patients with anterior infarction (mean maximal ST depression 1.45 ± 0.8 mm, p = 0.001). When initially present, reciprocal change had resolved within 24 hours in 59% of patients. The sum of reciprocal ST depression correlated with the sum of ST elevation in anterior (r = 0.92, p < 0.001) and inferior (r = 0.55, p = 0.035) infarction, and this relation persisted when maximal ST depression and elevation were considered. Echocardiographic: evidence of contraction abnormalities in areas of the left ventricle remote from the infarction was seen in 45% of patients. However, its presence did not correlate with the presence of reciprocal change. Although reciprocal change progressively diminished on serial electrocardiograms (maximal ST depression 2.73 ± 1.77 mm at 19 hours after onset of symptoms; 1.0 ± 0.92 mm at 2 to 3 days; and 0.22 ± 0.26 mm at 7 to 10 days; p < 0.05), the corresponding serial echocardiograms showed no change in the function of the remote wall (remote wall motion index 1.87 ± 0.65, 1.81 ± 0.62, 1.86 ± 0.47, respectively, p = NS) These data, therefore, do not support the hypothesis that reciprocal ST depressions during early acute transmural myocardial infarction reflect remote ischemia. Rather, these changes are influenced by factors determinng the degree of acute ST elevation, previously shown to include infarct size, shape, location, transmurality and duration.
AB - To evaluate the incidence, time course and significance of reciprocal change, 25 consecutive patients admitted with their first acute transmural myocardial infarction were studied with serial electrocardiography and two-dimensional echocardiography. Reciprocal change was noted in all patients with inferior infarction (mean maximal ST segment depression 3.53 ± 1.97 mm) and 70% of patients with anterior infarction (mean maximal ST depression 1.45 ± 0.8 mm, p = 0.001). When initially present, reciprocal change had resolved within 24 hours in 59% of patients. The sum of reciprocal ST depression correlated with the sum of ST elevation in anterior (r = 0.92, p < 0.001) and inferior (r = 0.55, p = 0.035) infarction, and this relation persisted when maximal ST depression and elevation were considered. Echocardiographic: evidence of contraction abnormalities in areas of the left ventricle remote from the infarction was seen in 45% of patients. However, its presence did not correlate with the presence of reciprocal change. Although reciprocal change progressively diminished on serial electrocardiograms (maximal ST depression 2.73 ± 1.77 mm at 19 hours after onset of symptoms; 1.0 ± 0.92 mm at 2 to 3 days; and 0.22 ± 0.26 mm at 7 to 10 days; p < 0.05), the corresponding serial echocardiograms showed no change in the function of the remote wall (remote wall motion index 1.87 ± 0.65, 1.81 ± 0.62, 1.86 ± 0.47, respectively, p = NS) These data, therefore, do not support the hypothesis that reciprocal ST depressions during early acute transmural myocardial infarction reflect remote ischemia. Rather, these changes are influenced by factors determinng the degree of acute ST elevation, previously shown to include infarct size, shape, location, transmurality and duration.
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U2 - 10.1016/S0735-1097(83)80160-0
DO - 10.1016/S0735-1097(83)80160-0
M3 - Article
C2 - 6863761
AN - SCOPUS:0020595580
SN - 0735-1097
VL - 2
SP - 251
EP - 257
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 2
ER -