Biomedical subjects
Publications and source records attributed to Antoni Bayés de Luna.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
OBJECTIVES: For over 50 years, Q-wave myocardial infarction (MI) location has been based on pathologic ECG studies. Although contrast-enhanced magnetic resonance (CE-CMR) is currently the "gold standard" technique for location and quantification of necrotic areas, we found no large study in the literature devoted to establish which ECG patterns corresponds to different MI location detected by CE-CMR. We hypothesized that CE-CMR would be very accurate for evaluating different ECG patterns and its sensitivity (SE) and specificity (SP) for locating MI in different LV areas. METHODS AND RESULTS: CE-CMR/ECG correlation was studied in 48 patients who presented a first MI due to acute coronary syndrome (ACS) with ST-segment elevation and in whom CE-CMR was performed in chronic phase. We evaluated the ECG patterns that best correlated with the 7 prespecified necrotic areas assessed by CE-CMR, 4 in anteroseptal zone (septal, apical/anteroseptal, extensive anterior, and limited anterolateral) and 3 in inferolateral zone (inferior, lateral and inferolateral). The global concordance between CE-CRM and ECG was of 75% and 7 ECG patterns were stablished. CONCLUSION: The capacity of CE-CMR to detect ECG patterns for necrotic area location presents highly acceptable concordance. Thanks to CE-CMR, we defined 7 ECG patterns for MI detection according to the 7 areas of the LV studied. The areas that present more cases with normal ECG are limited anterolateral and the areas of the inferolateral zone.
Sudden cardiac death (SCD) is a leading cause of mortality with an incidence of 3 million cases per year worldwide. Therapies for patients who have survived an SCD episode or have a high risk of developing lethal ventricular arrhythmia are well established and depend mainly on risk stratification. In this study we investigated the suitability of the non-linear measure compression entropy (Hc) for improved risk prediction in cardiac patients. We recorded 24-h Holter ECG for 300 patients with congestive heart failure (CHF). During a mean follow-up period of 12 months, 32 patients died due to a cardiac event. Hc depends on the compression parameters window length w and buffer length b, which were optimised by analysing a subgroup of patients. Compression entropies based on the beat-to-beat interval (BBI) were subsequently calculated and compared with standard heartrate variability parameters. Statistical analysis revealed significant differences between high- and low-risk CHF patients in standard HRV measures, as well as compression entropy based on the BBI (cardiac death, p = 0.005; SCD, p = 0.02). In conclusion, the implementation of non-linear compression entropy analysis in multivariate analysis seems to be useful for enhanced risk stratification of cardiac death, especially SCD, in ischaemic cardiomyopathy patients.
BACKGROUND: Patients with impaired left ventricular function have a high risk of developing ventricular arrhythmias and sudden death. Among different markers of risk, the prolongation and regional heterogeneity of repolarization are of increasing interest. However, there are limited data regarding feasibility of analyzing repolarization parameters and their dynamics in 24-hour Holter ECG recordings. METHODS: Dynamic behavior of repolarization parameters was studied with a new automatic algorithm in digital 24-hour Holter recordings of 60 healthy subjects and 55 patients with idiopathic dilated cardiomyopathy (IDC). Repolarization parameters included the mean value of QT and QTc durations, QT dispersion, and peaks of QT duration and QT dispersion above prespecified thresholds. RESULTS: In comparison to healthy subjects, patients with IDC had lower heart rate variability, longer mean QT and QTc durations, higher content of QTc peaks >500 ms, longer QT dispersion and its standard deviation, and a higher content of peaks >100 ms of QT dispersion (P < 0.01 for all comparisons). These repolarization parameters were significantly higher in IDC patients after adjustment for age, sex, and heart rate variability. The parameters of repolarization dynamics correlated with SDNN in healthy subjects but not in dilated cardiomyopathy patients. CONCLUSIONS: The automatic assessment of repolarization parameters in 24-hour digital ECG recordings is feasible and differentiates dilated cardiomyopathy patients from healthy subjects. Patients with dilated cardiomyopathy have increased QT duration, QT dispersion, and increased variability of QT dispersion reflecting variations in T-wave morphology, the factors which might predispose them to the development of arrhythmic events.
Acute myocardial infarction (AMI) of the inferoposterior wall is due to occlusion of the right coronary artery (RCA) or the left circumflex (LCx) coronary artery. The outcome of patients depends mainly on the culprit artery. Therefore, the presumptive prediction of a culprit artery based on the electrocardiogram recorded at admission is of clinical importance. The aim of this study was to develop a sequential algorithm based on the "ups and downs" of the ST segment in different leads to predict the culprit artery (RCA vs LCx) in cases of inferoposterior AMI. We analyzed electrocardiographic and angiographic findings of 63 consecutive patients with an evolving AMI with ST elevation in the inferior leads (II, III, and aVF) and a single-vessel occlusion. Specificity, sensitivity, and positive and negative predictive values of different electrocardiographic criteria (ups and downs of the ST segment) were studied individually and in combination to find an algorithm that would best predict the culprit artery. The following electrocardiographic criteria were included in the 3-step algorithm: (1) ST changes in lead I, (2) the ratio of ST elevation in lead III to that in lead II, and (3) the ratio of the sum of ST depression in precordial leads to the sum of ST elevation in inferior leads [( summation operator downward arrow ST in leads V(1) to V(3))/( summation operator upward arrow ST in leads II, III, and aVF)]. Application of this sensitive algorithm suggested the location of the culprit coronary artery (RCA vs LCx) in 60 of 63 patients (>95%). The few patients in whom this algorithm did not work were those with a very dominant LCx that presented ST depression of > or =0.5 mm in lead I. In conclusion, careful sequential analysis of an electrocardiogram of an inferoposterior AMI with ST elevation may lead to the identification of a culprit artery.
Explore the source record for details and available documents.
BACKGROUND: The outcome of patients with inferoposterior myocardial infarction (MI) due to occlusion of right coronary artery (RCA) depends mainly on the location of occlusion (distal vs. proximal). The aim of this study was to evaluate the value of new ECG criteria: the sum of ST depression in I and VL leads and ST changes in V1 lead to predict the location of RCA occlusion in the case of an inferoposterior MI. METHODS: The ECG and angiographical findings of 50 patients with acute inferoposterior MI due to RCA occlusion were analyzed. The value of new criteria was studied alone and in combination to predict proximal versus distal RCA occlusion and compared with previously described criterion based only on ST changes in VL. RESULTS: Isoelectric or elevated ST in V1 allowed predicting proximal RCA occlusion with 70% sensitivity and 87% specificity with high positive and negative predictive value (87% and 71%, respectively). The new criterion of the sum of ST depression in I and VL >or= 5.5 mm compared to the criterion based only on ST depression in VL was also more specific (91% vs. 72%) for proximal RCA occlusion with better positive and negative predictive values. CONCLUSIONS: The new criterion based on the ST changes in V1 lead is highly accurate in detecting the location of occlusion in the RCA compared to the criteria based only on ST changes in lateral leads. The use of this criterion might increase the accuracy of ECG-based identification of myocardial involvement in acute inferoposterior MI.
Explore the source record for details and available documents.