Clinical Studies
Electrocardiographic evolutionary changes and left ventricular remodeling after acute myocardial infarction1: Results of the GISSI-3 Echo substudy,

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Abstract

OBJECTIVES

The aim of this study was to describe the electrocardiographic (ECG) evolutionary changes after an acute myocardial infarction (AMI) and to evaluate their correlation with left ventricular function and remodeling.

BACKGROUND

The QRS complex changes after AMI have been correlated with infarct size and left ventricular function. By contrast, the significance of T wave changes is controversial.

METHODS

We studied 536 patients enrolled in the GISSI-3-Echo substudy who underwent ECG and echocardiographic studies at 24 to 48 h (S1), at hospital discharge (S2), at six weeks (S3) and six months (S4) after AMI.

RESULTS

The number of Q waves (nQ) and QRS quantitative score (QRSs) did not change over time. From S2 to S4, the number of negative T waves (nT NEG) decreased (p < 0.0001), wall motion abnormalities (%WMA) improved (p < 0.001), ventricular volumes increased (p < 0.0001) while ejection fraction remained stable. According to the T wave changes after hospital discharge, patients were divided into four groups: stable positive T waves (group 1, n = 35), patients who showed a decrease ≥1 in nT NEG (group 2, n = 361), patients with no change in nT NEG (group 3, n = 64) and those with an increase ≥1 in nT NEG (group 4, n = 76). The QRSs and nQ remained stable in all groups. Groups 3 and 4 showed less recovery in %WMA, more pronounced ventricular enlargement and progressive decline in ejection fraction than groups 1 and 2 (interaction time × groups p < 0.0001).

CONCLUSIONS

The analysis of serial ECG can predict postinfarct left ventricular remodeling. Normalization of negative T waves during the follow-up appears more strictly related to recovery of regional dysfunction than QRS changes. Lack of resolution and late appearance of new negative T predict unfavorable remodeling with progressive deterioration of ventricular function.

Abbreviations

AMI
acute myocardial infarction
ECG
electrocardiographic
nQ
number of Q waves at 12-lead ECG
nT NEG
the number of negative T waves at 12-lead electrocardiogram
QRSs
quantitative QRS scoring system
%WMA
the percentage of wall motion abnormalities at echocardiographic study

Cited by (0)

The study was endorsed by the Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO, Italy) and the Istituto di Ricerche Farmacologiche “Mario Negri,” Milano, Italy, and supported in part by grants from Zeneca Italy, Schwarz Pharma Italy, and Cardiovascular Reasearch Foundation, Bad Schwalbach, Germany.

1

The Investigators and Institutions participating in the GISSI-3 Echo Substudy are listed in the Appendix.