ST-segment elevation myocardial infarction and the clinical significance of differentiated electrocardiogram

Authors

DOI:

https://doi.org/10.14739/2310-1210.2023.3.267269

Keywords:

myocardial infarction, ST elevation myocardial infarction, electrocardiogram

Abstract

Aim. To evaluate the markers of changing dynamics recorded by digital processing of routine ECG using own diagnostic complex software “Smart-ECG” in patients with ST-segment elevation myocardial infarction (STEMI) based on the results of a 40-day follow-up.

Materials and methods. The main group consisted of 20 patients with STEMI according to the ESC guidelines (2017) (mean age of males 56.11 ± 11.62, n = 10; mean age of females 58.22 ± 13.11, n = 10). ECG were analyzed using own developed diagnostic complex software “Smart-ECG” on the 1st, 10th, 40th day after STEMI. The first derivative of T wave – ratio of maximum velocity (MVR), inclination angle (β) and inclination height (H) of ST segment was calculated. The control group – 20 apparently healthy people.

Results. MVR indicators decreased by 61.90 %, 68.20 % and 51.48 % on the 1st, 10th and 40th day, respectively, after STEMI as compared to those of the control group (p < 0.01). At the moment of the maximum ST segment elevation, the height (H) of ST inclination was 347.7 % increased (p < 0.01); on the 40th day, H was 25 % increased, close to control indicators, with ST segment shift to isoline (р > 0.05). During the acutest period, the angle β increased by 172.2 % (p < 0.01) and then decreased by 15.8 % at the recovery phase, but insignificantly.

Conclusions. Self-developed medical software “Smart-ECG” for qualitative evaluation of ECG is an effective tool to diagnose pathological changes in the myocardium, makes it possible to improve the specificity, sensitivity and prognostic significance of ECG in STEMI. The significant decrease in MVR has been detected at all stages of STEMI, which was associated with a violation of electrogenesis in the repolarization phase; the critical increase in ST slope indicators (angle β and height H) on the 1st day has been found as a characteristic of ST elevation, as well as its decrease on the 40th day as a sign of reduced potential difference between healthy and damaged areas of the myocardium during the recovery stage.

Author Biographies

V. K. Tashchuk, Bukovinian State Medical University, Chernivtsi, Ukraine

MD, PhD, DSc, Professor, Head of the Department of Internal Medicine, Physical Rehabilitation and Sport Medicine

O. V. Malinevska-Biliichuk, Bukovinian State Medical University, Chernivtsi, Ukraine

MD, Postgraduate student of the Department of Internal Medicine, Physical Rehabilitation and Sport Medicine

P. R. Ivanchuk, Bukovinian State Medical University, Chernivtsi, Ukraine

MD, PhD, Associated Professor of the Department of Internal Medicine, Physical Rehabilitation and Sport Medicine

O. S. Polianska, Bukovinian State Medical University, Chernivtsi, Ukraine

MD, PhD, DSc, Professor of the Department of Internal Medicine, Physical Rehabilitation and Sport Medicine

References

Lopez-Jimenez, F., Attia, Z., Arruda-Olson, A. M., Carter, R., Chareonthaitawee, P., Jouni, H., Kapa, S., Lerman, A., Luong, C., Medina-Inojosa, J. R., Noseworthy, P. A., Pellikka, P. A., Redfield, M. M., Roger, V. L., Sandhu, G. S., Senecal, C., & Friedman, P. A. (2020). Artificial Intelligence in Cardiology: Present and Future. Mayo Clinic proceedings, 95(5), 1015-1039. https://doi.org/10.1016/j.mayocp.2020.01.038

Mohamed, A. (2021). Predicting mortality and no-reflow in STEMI patients using epicardial adipose tissue. Clinical cardiology, 44(10), 1371-1376. https://doi.org/10.1002/clc.23692

Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Alonso, A., Beaton, A. Z., Bittencourt, M. S., Boehme, A. K., Buxton, A. E., Carson, A. P., Commodore-Mensah, Y., Elkind, M. S. V., Evenson, K. R., Eze-Nliam, C., Ferguson, J. F., Generoso, G., Ho, J. E., Kalani, R., Khan, S. S., Kissela, B. M., Knutson, K. L., … Martin, S. S. (2022). Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation, 145(8), e153-e639. https://doi.org/10.1161/CIR.0000000000001052

Bhatt, D. L., Lopes, R. D., & Harrington, R. A. (2022). Diagnosis and Treatment of Acute Coronary Syndromes: A Review. JAMA, 327(7), 662-675. https://doi.org/10.1001/jama.2022.0358

Tashchuk, V. K., Ivanchuk, P. R., Tashchuk, M. V., Polyanska, O. S., Amelina, T. M., Makoviychuk, I. O., Onofreychuk, D. I., & Shevchuk, V. A. (2017). Kilkisna otsinka elektrokardiohramy v porivnianni efektyvnosti kardioprotektsii pry hostromu infarkti miokarda [Quantitative evaluation of electrocardiogram in comparison of cardioprotection efficiency in acute myocardial infarction]. Bukovynskyi medychnyi visnyk, 21(2, Pt 1), 94-99. [in Ukrainian]. https://doi.org/10.24061/2413-0737.XXI.2.82.1.2017.20

Tashchuk, V. K., Ivanchuk, P. R., Amelina, T. M., & Tashchuk, M. V. (2018). Kardioprotektyvni efekty metabolichnoi terapii u khvorykh na ishemichnu khvorobu sertsia: analiz tsyfrovoi obrobky elektrokardiohramy za dopomohoiu prohramnoho kompleksu "Smart-EKH" [Cardioprotective effects of metabolic therapy in patients with ischemic heart disease: analysis of digital electrocardiogram of electrocardiograms using the software complex "Smart-ECG"]. Klinichna ta eksperymentalna patolohiia, 17(2), 91-98. [in Ukrainian]. https://doi.org/10.24061/1727-4338.XVII.2.64.2018.18

Tashchuk, V. K., Ivanchuk, P. R., Polianska, O. S., Tashchuk, K. G., & Savchuk, O. V. (2018). Osoblyvosti zastosuvannia metabolichnoi terapii u khvorykh na hostru ta khronichnu ishemichnu khvorobu sertsia: analiz tsyfrovoi obrobky elektrokardiohramy za dopomohoiu prohramnoho kompleksu "Smart-EKH" [Peculiarities of the metabolic therapy use in patients with acute and chronic ischemic heart disease: analysis of digital processing of electrocardiogram]. Klinichna ta eksperymentalna patolohiia, 17(2), 99-106. [in Ukrainian]. https://doi.org/10.24061/1727-4338.XVII.2.64.2018.19

Tashchuk, V. K., Polianska, O. S., Ivanchuk, P. R., Amelina, T. M., & Tashchuk, M. V. (2018). Kardioprotektsiia u khvorykh zi stabilnoiu stenokardiieiu: analiz tsyfrovoi obrobky elektrokardiohramy [Cardioprotection in patients with ischemic heart disease evaluated by digital processing of electrocardiogram]. Ukrainskyi kardiolohichnyi zhurnal, (5), 39-44. [in Ukrainian]. https://doi.org/10.31928/1608-635X-2018.5.3944

Tashchuk, V. K., Tashchuk, M. V., & Ivanchuk, P. R. (2019). Dyhitalizatsiia elektrokardiohrafii i fotopletyzmohrafiia: klinichne vprovadzhennia kilkisnoho analizu sertsevoho rytmu [Digitization of electrocardiography and photoplethysmography: clinical implementation of a quantity analysis of the heart rhytm]. Klinichna ta eksperymentalna patolohiia, 18(2), 80-85. [in Ukrainian]. https://doi.org/10.24061/1727-4338.XVIII.2.68.2019.14

Tashchuk, V. K., Polianska, O. S., Ivanchuk, P. R., Nesterovska, R. A., & Tashchuk, M. V. (2020). Otsinka efektyvnosti kardiotsytoprotektsii v likuvanni khvorykh na hostryi infarkt miokarda ta stabilnu stenokardiiu shliakhom tsyfrovoi obrobky EKH (dyhitalizatsii) z podalshoiu yii ekspertnoiu otsinkoiu [Evaluation of the cardioprotection efficiency in the treatment of patients with acute myocardial infarction and stable angina pectoris by means of digital processing of ECG (digitalization) with subsequent expert assesment]. Bukovynskyi medychnyi visnyk, 24(1), 142-151. [in Ukrainian]. https://doi.org/10.24061/2413-0737.XXIV.1.93.2020.19

de Bliek, E. C. (2018). ST elevation: Differential diagnosis and caveats. A comprehensive review to help distinguish ST elevation myocardial infarction from nonischemic etiologies of ST elevation. Turkish journal of emergency medicine, 18(1), 1-10. https://doi.org/10.1016/j.tjem.2018.01.008

Ibánez, B., James, S., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H., Caforio, A. L. P., Crea, F., Goudevenos, J. A., Halvorsen, S., Hindricks, G., Kastrati, A., Lenzen, M. J., Prescott, E., Roffi, M., Valgimigli, M., Varenhorst, C., Vranckx, P., & Widimský, P. (2017). 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Revista espanola de cardiologia (English ed.), 70(12), 1082. https://doi.org/10.1016/j.rec.2017.11.010

Beckenbauer, D., Martínez Pereyra, V., & Ong, P. (2020). STEMI-Äquivalente im EKG – eine fallbasierte Darstellung [STEMI equivalents on the ECG - a case-based presentation]. Deutsche medizinische Wochenschrift (1946), 145(5), 318-326. https://doi.org/10.1055/a-0999-0101

Birnbaum, Y., Rankinen, J., Jneid, H., Atar, D., & Nikus, K. (2022). The Role of ECG in the Diagnosis and Risk Stratification of Acute Coronary Syndromes: an Old but Indispensable Tool. Current cardiology reports, 24(2), 109-118. https://doi.org/10.1007/s11886-021-01628-7

Choi, Y. J., Park, M. J., Ko, Y., Soh, M. S., Kim, H. M., Kim, C. H., Lee, E., & Kim, J. (2022). Artificial intelligence versus physicians on interpretation of printed ECG images: Diagnostic performance of ST-elevation myocardial infarction on electrocardiography. International journal of cardiology, 363, 6-10. https://doi.org/10.1016/j.ijcard.2022.06.012

Kim, D., Hwang, J. E., Cho, Y., Cho, H. W., Lee, W., Lee, J. H., Oh, I. Y., Baek, S., Lee, E., & Kim, J. (2022). A Retrospective Clinical Evaluation of an Artificial Intelligence Screening Method for Early Detection of STEMI in the Emergency Department. Journal of Korean medical science, 37(10), e81. https://doi.org/10.3346/jkms.2022.37.e81

Langner, P. H., Jr, Geselowitz, D. B. (1962). First derivative of the electrocardiogram. Circulation research, 10, 220-226. https://doi.org/10.1161/01.res.10.2.220

Tashchuk, V. K., Ivanchuk, P. R., Polianska, O. S., & Rusnak, I. T. (2015). Pobudova prohramnoho zabezpechennia dlia kilkisnoi otsinky elektrokardiohramy: mozhlyvosti i doslidzhennia zubtsia T [Software design for quantitative evaluation of electrocardiogram: possibilities and wave examination]. Klinichna anatomiia ta operatyvna khirurhiia, 14(4), 10-16. [in Ukrainian].

Chaikovsky, I. A., Batushkin, V. V., Fainzilberg, L. S., Stadnyuk, L. A., Semergey, N. A., Chicherova, T. S., & Kholodnyak, I. V. (2007). Effektivnost otsenki techeniya ostrogo koronarnogo sindroma po dannym analiza odnokanalnoi EKG na fazovoi ploskosti [Efficiency of assessment of acute coronary syndrome course based on analysis of the ecg first lead on the phase plane]. Zhurnal AMN Ukrainy, 13(1), 102-108. [in Russian].

Kenny, B. J., & Brown, K. N. (2022). ECG T Wave. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/pubmed/30855852

Sattler, S. M., Skibsbye, L., Linz, D., Lubberding, A. F., Tfelt-Hansen, J., & Jespersen, T. (2019). Ventricular Arrhythmias in First Acute Myocardial Infarction: Epidemiology, Mechanisms, and Interventions in Large Animal Models. Frontiers in cardiovascular medicine, 6, 158. https://doi.org/10.3389/fcvm.2019.00158

Ghafoor, M., Kamal, M., Nadeem, U., & Husain, A. N. (2020). Educational Case: Myocardial Infarction: Histopathology and Timing of Changes. Academic pathology, 7, 2374289520976639. https://doi.org/10.1177/2374289520976639

Reindl, M., Reinstadler, S. J., Feistritzer, H. J., Niess, L., Koch, C., Mayr, A., Klug, G., & Metzler, B. (2017). Persistent T-wave inversion predicts myocardial damage after ST-elevation myocardial infarction. International journal of cardiology, 241, 76-82. https://doi.org/10.1016/j.ijcard.2017.03.164

Lindow, T., Engblom, H., Pahlm, O., Carlsson, M., Lassen, A. T., Brabrand, M., Lundager Forberg, J., Platonov, P. G., & Ekelund, U. (2021). Low diagnostic yield of ST elevation myocardial infarction amplitude criteria in chest pain patients at the emergency department. Scandinavian cardiovascular journal : SCJ, 55(3), 145-152. https://doi.org/10.1080/14017431.2021.1875138

Published

2023-05-31

How to Cite

1.
Tashchuk VK, Malinevska-Biliichuk OV, Ivanchuk PR, Polianska OS. ST-segment elevation myocardial infarction and the clinical significance of differentiated electrocardiogram. Zaporozhye Medical Journal [Internet]. 2023May31 [cited 2024Jun.18];25(3):193-7. Available from: http://zmj.zsmu.edu.ua/article/view/267269