The value of perioperative ECG in patients with complicated forms of coronary artery disease
DOI:
https://doi.org/10.14739/2310-1210.2021.1.224977Keywords:
ECG, complication, miocardial ischemia, high-risk patients, perioperative periodAbstract
The aim: to analyze the informativeness and features of the perioperative electrocardiogram dynamics in complicated forms of coronary artery disease (CAD).
Material and methods: retrospective ECG analysis of 100 randomized high-risk patients with complicated forms of CAD who underwent surgery in the National M. Amosov Institute of Cardiovascular Surgery Affiliated to National Academy of Medical Sciences of Ukraine from 2009 to 2019. All the patients included in the study were classified as high-risk group for complications and mortality and had an average risk of 8.60 % (from 5.02 % to 39.38 %) according to the EuroSCORE II scale.
Results. Postinfarction left ventricular aneurysm (ALV) was localized in the anteroseptal region of the left ventricle (LV) in 94 (94 %) cases, and posterior-basal LV aneurysm (PBALV) was diagnosed in 6 (6 %) patients. Mitral insufficiency (MI) was detected in 8 (8.5 %) patients with anterior ALV and in 2 (33.3 %) cases of PBALV. Tricuspid valve insufficiency (TI) was diagnosed in 4 (4.2 %) patients with anterior ALV, and postinfarction defect of the interventricular septum (VSD) was verified in 2 (33.3 %) patients with PBALV. Diagnostics of anteroseptal ALV using ECG is highly accurate, the specificity of the method is 94 %, and the sensitivity is 95.6 %. ECG interpretation after surgery presents with certain difficulties, since nonspecific changes of the terminal part of the ventricular complex often occur that being interpreted correctly determine further treatment tactics. Positive ECG dynamics was detected in 66 (66 %) patients in the form of improved intraventricular conduction and the appearance of the R wave in leads I, avL, V2-V6, a lack of dynamics – in 11 (11 %), as a rule, in patients with complete left bundle branch block (LBBB), dry pericarditis of II–III stage was diagnosed in 23 (23 %) patients.
Conclusions. ECG retains its importance and remains an informative and available method in modern cardiology. The correct ECG interpretation before surgery helps to assess the initial severity of the condition and timely correct the therapy and management tactics in the early postoperative period.
References
Neumann, F.-J., Sousa-Uva, M., Ahlsson, A., Alfonso, F., Banning, A. P., Benedetto, U., Byrne, R. A., Collet, J. P., Falk, V., Head, S. J., Jüni, P., Kastrati, A., Koller, A., Kristensen, S. D., Niebauer, J., Richter, D. J., Seferovic, P. M., Sibbing, D., Stefanini, G. G., Windecker, S., … ESC Scientific Document Group. (2019). 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal, 40(2), 87-165. https://doi.org/10.1093/eurheartj/ehy394
Michler, R. E., Rouleau, J. L., Al-Khalidi, H. R., Bonow, R. O., Pellikka, P. A., Pohost, G. M., Holly, T. A., Oh, J. K., Dagenais, F., Milano, C., Wrobel, K., Pirk, J., Ali, I. S., Jones, R. H., Velazquez, E. J., Lee, K. L., Di Donato, M., & STICH Trial Investigators. (2013). Insights from the STICH trial: change in left ventricular size after coronary artery bypass grafting with and without surgical ventricular reconstruction. The Journal of Thoracic and Cardiovascular Surgery, 146(5), 1139-1145.e6. https://doi.org/10.1016/j.jtcvs.2012.09.007
Oh, J. K., Velazquez, E. J., Menicanti, L., Pohost, G. M., Bonow, R. O., Lin, G., Hellkamp, A. S., Ferrazzi, P., Wos, S., Rao, V., Berman, D., Bochenek, A., Cherniavsky, A., Rogowski, J., Rouleau, J. L., Lee, K. L., & STICH Investigators. (2013). Influence of baseline left ventricular function on the clinical outcome of surgical ventricular reconstruction in patients with ischaemic cardiomyopathy. European Heart Journal, 34(1), 39-47. https://doi.org/10.1093/eurheartj/ehs021
Jones, R. H., Velazquez, E. J., Michler, R. E., Sopko, G., Oh, J. K., O'Connor, C. M., Hill, J. A., Menicanti, L., Sadowski, Z., Desvigne-Nickens, P., Rouleau, J. L., Lee, K. L., & STICH Hypothesis 2 Investigators. (2009). Coronary Bypass Surgery with or without Surgical Ventricular Reconstruction. The New England Journal of Medicine, 360(17), 1705-1717. https://doi.org/10.1056/NEJMoa0900559
Sharma, A., & Kumar, S. (2015). Overview of left ventricular outpouchings on cardiac magnetic resonance imaging. Cardiovascular Diagnosis and Therapy, 5(6), 464-470. https://doi.org/10.3978/j.issn.2223-3652.2015.11.02
Mahjoob, M. P., Piranfar, M. A., Maghami, E., Mazarei, A., Khaheshi, I., & Naderian, M. (2019). Diagnostic value of speckle tracking echocardiography (STE) in the determination of myocardial ischemia: a pilot study. Polish Annals of Medicine, 26(2), 126-129. https://doi.org/10.29089/019.19.00083
Ko, S. M., Hwang, S. H., & Lee, H. J. (2019). Role of Cardiac Computed Tomography in the Diagnosis of Left Ventricular Myocardial Diseases. Journal of Cardiovascular Imaging, 27(2), 73-92. https://doi.org/10.4250/jcvi.2019.27.e17
Ko, S. M., Kim, T. H., Chun, E. J., Kim, J. Y., & Hwang, S. H. (2019). Assessment of Left Ventricular Myocardial Diseases with Cardiac Computed Tomography. Korean Journal of Radiology, 20(3), 333-351. https://doi.org/10.3348/kjr.2018.0280
Cho, Y. H., Kang, J. W., Choi, S. H., Yang, D. H., Anh, T., Shin, E. S., & Kim, Y. H. (2019). Reference parameters for left ventricular wall thickness, thickening, and motion in stress myocardial perfusion CT: Global and regional assessment. Clinical Imaging, 56, 81-87. https://doi.org/10.1016/j.clinimag.2019.04.002
Weinsaft, J. W., Kim, J., Medicherla, C. B., Ma, C. L., Codella, N. C., Kukar, N., Alaref, S., Kim, R. J., & Devereux, R. B. (2016). Echocardiographic Algorithm for Post-Myocardial Infarction LV Thrombus: A Gatekeeper for Thrombus Evaluation by Delayed Enhancement CMR. JACC: Cardiovascular Imaging, 9(5), 505-515. https://doi.org/10.1016/j.jcmg.2015.06.017
Sengeløv, M., Jørgensen, P. G., Jensen, J. S., Bruun, N. E., Olsen, F. J., Fritz-Hansen, T., Nochioka, K., & Biering-Sørensen, T. (2015). Global Longitudinal Strain Is a Superior Predictor of All-Cause Mortality in Heart Failure With Reduced Ejection Fraction. JACC: Cardiovascular Imaging, 8(12), 1351-1359. https://doi.org/10.1016/j.jcmg.2015.07.013
Kim, J., Rodriguez-Diego, S., Srinivasan, A., Brown, R. M., Pollie, M. P., Di Franco, A., Goldburg, S. R., Siden, J. Y., Ratcliffe, M. B., Levine, R. A., Devereux, R. B., & Weinsaft, J. W. (2017). Echocardiography-quantified myocardial strain-a marker of global and regional infarct size that stratifies likelihood of left ventricular thrombus. Echocardiography, 34(11), 1623-1632. https://doi.org/10.1111/echo.13668
Klein, L. R., Shroff, G. R., Beeman, W., & Smith, S. W. (2015). Electrocardiographic criteria to differentiate acute anterior ST-elevation myocardial infarction from left ventricular aneurysm. The American Journal of Emergency Medicine, 33(6), 786-790. https://doi.org/10.1016/j.ajem.2015.03.044
Ning, X., Ye, X., Si, Y., Yang, Z., Zhao, Y., Sun, Q., Chen, R., Tang, M., Chen, K., Zhang, X., & Zhang, S. (2018). Prevalence and prognosis of ventricular tachycardia/ventricular fibrillation in patients with post-infarction left ventricular aneurysm: Analysis of 575 cases. Journal of Electrocardiology, 51(4), 742-746. https://doi.org/10.1016/j.jelectrocard.2018.03.010
Ola, O., Dumancas, C., Mene-Afejuku, T. O., Akinlonu, A., Al-Juboori, M., Visco, F., Mushiyev, S., & Pekler, G. (2017). Left Ventricular Aneurysm May Not Manifest as Persistent ST Elevation on Electrocardiogram. American Journal of Case Reports, 18, 410-413. https://doi.org/10.12659/ajcr.902884
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
