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ȣ - 490701 139 |
| The Relationship Between the Degree of Electrocardiographic ST Segment Deviation and the Echocardiographic
Wall Motion Score Index (WMSI) in Acute
Non-ST Elevation Myocardial Infarction (NSTEMI)
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| 연세대학교 의과대학 신촌세브란스병원, 심장혈관병원, 심장내과 |
| 조정래, 심지영, 김진배, 박성하, 고영국, 최동훈, 장양수, 정남식, 심원흠, 조승연 |
Background: Significant ST segment depression in ECG is known to be an independent risk factor for acute coronary syndrome. The degree of ST segment deviation in multiple leads may reflect severity of ischemia in multi-vascular territories and may be associated with the severity of echocardiographic WMSI.
In this study, we hypothesized that the degree of ST segment depression in patients with NSTEMI will significantly correlate with WMSI.
Methods: We analyzed the initial ECG, echocardiogram, coronary angiogram with LV pressure monitor in 89 patients admitted to our institution between Jan 2002 and Dec 2003, and diagnosed with acute NSTEMI for the first time. The degree of ST segment depression was evaluated using a novel ST depression score (STD score) which is the sum of amplitude of ST segment depression divided by the number of affected leads in initial ECG.
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Results:
Fig 1. Clinical
characteristics of the patients (n=89)
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Group
I
STD score <1
(n=55) |
Group
II
STD score
³ 1
(n=34) |
p value |
|
Age |
56.60±10.63 |
60.53±8.87 |
0.075 |
|
Sex
(M/F) |
37 /
18 |
28 /
6 |
NS |
|
Hypertension |
29
(53%) |
17
(50%) |
NS |
|
Diabetes |
18
(33%) |
10
(29%) |
NS |
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Ejection
fraction |
55.77±9.96 |
50.59±10.44 |
0.022 |
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Number of wall motion
abnormality |
3.38±2.45 |
5.06±3.22 |
0.009 |
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WMSI |
1.29±0.25 |
1.47±0.37 |
0.013 |
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CAD
severity |
1.98±1.06 |
2.79±1.32 |
0.002 |
|
Left main disease / 3
vessel disease |
17
(30%) |
22
(65%) |
0.002 |
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Hospital
stay |
8.93±4.43 |
11.88±6.73 |
0.032 |
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Hospital
MACE |
1
(1.8%) |
3
(9.4%) |
NS |
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Follow-up event free
duration |
20.12±8.58 |
14.71±11.35 |
0.086 |
Cf. CAD severity is graded
as this: 1=1 vessel disease, 2=2 vessel disease, 3=3 vessel disease, 4=left main
disease±3 vessel
disease.
Fig 2. Correlation between STD score and other
parameters
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Correlation with STD
score |
R2 |
p value |
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CAD
severity |
0.395 |
p = 0.012 |
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Left ventricular
end-diastolic pressure |
0.448 |
p = 0.009 |
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WMSI |
0.359 |
p =
0.025 |
Conclusion: The
degree of ST depression is significantly correlated with increased
echocardiographic WMSI. The severity of subendocardial ischemia, reflected by
the degree of ST depression, may be related to the adverse resting wall motion
abnormalities.
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