Journal article
New or presumably new left bundle branch block in patients with suspected acute coronary syndrome: Clinical, echocardiographic, and electrocardiographic features from a single-center registry
Journal of electrocardiology, Vol.48(4), pp.505-511
07/01/2015
DOI: 10.1016/j.jelectrocard.2015.04.011
PMID: 25981236
Abstract
Background: In patients with suspected acute coronary syndrome, a new or presumably new left bundle branch block (LBBB) does not always imply ST-segment elevation myocardial infarction (STEMI). We aimed to show the low frequency of STEMI-equivalent in this population and determine the diagnostic value of electrocardiographic and echocardiographic features.
Methods: From the 387 patients captured by the Louisiana State University code STEMI registry between 2009 and 2012, we examined data on 26 patients with LBBB. These patients were divided into 3 groups according to the final diagnosis: (1) STEMI-equivalent, defined as an acute coronary occlusion on angiography (2 patients), (2) non-ST-segment elevation myocardial infarction (4 patients), and (3) diagnoses other than myocardial infarction (non-MI) (20 patients).
Results: Troponin elevation and left ventricular systolic dysfunction were common in all 3 groups (non-significant p-values). Compared with non-MI patients, patients with STEMI-equivalent had a larger degree of ST-segment discordance and T-wave discordance, as assessed by ST/QRS and T/QRS ratios (p <0.001). ST/QRS ratio >= 0.2 and T/QRS ratio >= 0.5 were sensitive and specific for the diagnosis of STEMI-equivalent in the setting of LBBB. Conversely, absolute values of ST-segment and T-wave discordance were not significantly different between groups. ST-segment concordance was highly specific for the diagnosis of STEMI-equivalent, but had a limited sensitivity.
Conclusion: Only a minority of patients with suspected acute coronary syndrome and LBBB have a STEM I-equivalent. Excessive relative discordance of the ST segment or the T wave appears predictive of STEMI-equivalent, but this is only hypothesis-generating considering the small population size. (C) 2015 Elsevier Inc. All rights reserved.
Details
- Title: Subtitle
- New or presumably new left bundle branch block in patients with suspected acute coronary syndrome: Clinical, echocardiographic, and electrocardiographic features from a single-center registry
- Creators
- Elias B. Hanna - Louisiana State UniversityViral N. Lathia - University Hospital and ClinicsMurtuza Ali - Louisiana State UniversityEliana Hanna Deschamps - University Hospital of Geneva
- Resource Type
- Journal article
- Publication Details
- Journal of electrocardiology, Vol.48(4), pp.505-511
- Publisher
- Elsevier
- DOI
- 10.1016/j.jelectrocard.2015.04.011
- PMID
- 25981236
- ISSN
- 0022-0736
- eISSN
- 1532-8430
- Number of pages
- 7
- Language
- English
- Date published
- 07/01/2015
- Academic Unit
- Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984359934702771
Metrics
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