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. 2004 Aug;90(8):887-92.
doi: 10.1136/hrt.2003.012955.

Relation between different methods for analysing ST segment deviation and infarct size as assessed by positron emission tomography

W J Desmet  1 , L V Mesotten, A F Maes, H P Heidbüchel, L A Mortelmans, F J Van de Werf
Affiliations

Relation between different methods for analysing ST segment deviation and infarct size as assessed by positron emission tomography

W J Desmet et al. Heart. 2004 Aug.

Abstract

Objective: To study the relation between resolution of ST segment deviation and infarct size using positron emission tomography.

Methods: 45 patients with ST segment elevation acute myocardial infarction treated with thrombolysis or percutaneous coronary intervention were studied prospectively. An ECG was taken before and at (mean (SD)) 100 (45) min after reperfusion therapy. ECGs were analysed by three methods. Residual ST segment deviation, obtained from the ECG immediately after completion of reperfusion therapy, was defined by summation for each of the three methods. Relative resolution of ST segment deviation was defined as the absolute resolution divided by the ST segment deviation score at baseline x 100 (%). After 29 (14) hours, myocardial blood flow was measured with 13NH3. For each patient, the regions with a myocardial blood flow < 80% of normally perfused myocardium ( = hypoperfusion) and < 50% ( = no reflow) were automatically delineated.

Results: Substantial differences were found between different ECG analysis methods. There were moderate correlations between the area with myocardial hypoperfusion and ST segment deviation scores at baseline and after reperfusion therapy. After reperfusion therapy, residual ST segment deviation in the single lead with maximum ST segment deviation was as good at discriminating between tertiles of myocardial damage as summed ST segment elevation. Relative ST segment resolution did not discriminate between different degrees of myocardial damage.

Conclusions: In the individual patient, residual ST segment deviation after reperfusion in the single lead with maximum ST segment deviation is at least as good as summed ST elevation in predicting final myocardial damage.

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Figures

Figure 1
Figure 1
Examples of ECGs before and after reperfusion therapy in a patient with a large anterior (A) and a small inferior (B) ST segment elevation acute myocardial infarct (STEMI). The area with myocardial hypoperfusion (light and dark grey in panel A) and the area of no reflow (dark grey in panel A) were automatically defined. The patient in panel B had only a limited area of myocardial hypoperfusion (light grey in panel B), but no region with no reflow.
Figure 2
Figure 2
Schematic representation of the numbers of patients showing complete (> 70%) resolution of ST segment deviation according to the three different ECG analysis methods. STD, ST deviation; STE, ST elevation.
Figure 3
Figure 3
(A) Scatterplot for ST segment deviation after reperfusion therapy (mV). (B) Scatterplot for relative ST segment deviation resolution (mV). Method 1, summed ST elevation; method 3, maximum ST elevation.
See this image and copyright information in PMC

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