ST and T-Wave Abnormality as Footprint of Myocardial Oedema in Non–ST-Elevation Myocardial Infarction

Layland, J., Tong, D., Lee, M. and Berry, C. (2018) ST and T-Wave Abnormality as Footprint of Myocardial Oedema in Non–ST-Elevation Myocardial Infarction. 66th Cardiac Society of Australia and New Zealand Annual Scientific Meeting, the International Society for Heart Research Australasian Section Annual Scientific Meeting and the 12th Annual Australia and New Zealand Endovascular Therapies Meeting, Brisbane, Australia, 02-05 Aug 2018. S274-S275. (doi: 10.1016/j.hlc.2018.06.515)

Abstract

Background: Heterogeneity of non–ST-elevation myocardial infarction (NSTEMI) presentations often leads to delay in diagnosis and adverse outcomes. The presence of ST/T-wave abnormality is common in this population, despite its pathophysiological mechanism remaining unclear. Methods: Twelve-lead electrocardiography (ECG) and cardiac magnetic resonance were acquired on a cohort of NSTEMI patients. Electrocardiograms were classified according to patterns of presentation: isolated T-wave abnormality, isolated ST depression, ST depression+T-wave abnormality, no ST- or T-wave abnormalities. Myocardial oedema was determined on T2-weighted images by two independent magnetic resonance imaging-trained cardiologists who were blinded to clinical information. Demographics, angiographic characteristics, cardiac markers, and cardiac risk scores were recorded. Results: Of 74 subjects (81% male, mean age 56.8 ± 9.4 years), 28 showed isolated T-wave abnormalities, 13 isolated ST depression, 29 ST depression+T-wave abnormality, and four normal/non–ischaemic ECG. Baseline characteristics and angiographic findings were similar between oedema-positive (66 subjects) and oedema-negative (eight subjects) groups. Ischaemic ECG changes were more prevalent in oedema-positive subjects (97% vs 75%; p = 0.009). Peak troponin (5.59 mg/dL vs 0.27 mg/dL; p < 0.0001), T2-weighted total ischaemic area at risk (AAR; 17.20% vs 0.24% [p < 0.0001]), and infarct size (5.74% vs 0.06%; p = 0.003) were greater in the oedema-positive group. By logistic regression analyses, an ischaemic ECG (odds ratio [OR] 10.67, 95% confidence interval [CI] 1.27–89.86; p = 0.03), T1-weighted segmental AAR (OR 2.12, 95% CI 1.14–3.95; p = 0.02), and T2-weighted total AAR (OR 5.28, 95% CI 1.07–26.04; p = 0.04) were significant predictors of myocardial oedema. Conclusions: ST- and T-wave abnormalities on 12-lead ECG are associated with presence of myocardial oedema in NSTEMI patients.

• Item Type: Conference or Workshop Item
• Additional Information: Conference abstract published in Heart, Lung and Circulation 27(Supplement 2): S274-S275.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lee, Matthew and Layland, Dr Jamie and Berry, Professor Colin
• Authors: Layland, J., Tong, D., Lee, M., and Berry, C.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• ISSN: 1443-9506
• Published Online: 26 July 2018