New electrocardiographic criteria to differentiate acute pericarditis and myocardial infarction
Rossello, Xavier (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Wiegerinck, Rob F. (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Alguersuari, Joan (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Bardají, Alfredo (Hospital Universitari Joan XXIII de Tarragona)
Worner, Fernando (Hospital Arnau de Vilanova (Lleida, Catalunya))
Sutil, Mario (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Ferrero-Gregori, Andreu (Institut d'Investigació Biomèdica Sant Pau)
Cinca, Juan (Institut d'Investigació Biomèdica Sant Pau)

Date:	2014
Abstract:	Objective Transmural myocardial ischemia induces changes in QRS complex and QT interval duration but, theoretically, these changes might not occur in acute pericarditis provided that the injury is not transmural. This study aims to assess whether QRS and QT duration permit distinguishing acute pericarditis and acute transmural myocardial ischemia. Methods Clinical records and 12-lead electrocardiogram (ECG) at ×2 magnification were analyzed in 79 patients with acute pericarditis and in 71 with acute ST-segment elevation myocardial infarction (STEMI). Results ECG leads with maximal ST-segment elevation showed longer QRS complex and shorter QT interval than leads with isoelectric ST segment in patients with STEMI (QRS: 85. 9 ± 13. 6 ms vs 81. 3 ± 10. 4 ms, P =. 01; QT: 364. 4 ± 38. 6 vs 370. 9 ± 37. 0 ms, P =. 04), but not in patients with pericarditis (QRS: 81. 5 ± 12. 5 ms vs 81. 0 ± 7. 9 ms, P =. 69; QT: 347. 9 ± 32. 4 vs 347. 3 ± 35. 1 ms, P =. 83). QT interval dispersion among the 12-ECG leads was greater in STEMI than in patients with pericarditis (69. 8 ± 20. 8 ms vs 50. 6 ± 20. 2 ms, P <. 001). The diagnostic yield of classical ECG criteria (PR deviation and J point level in lead aVR and the number of leads with ST-segment elevation, ST-segment depression, and PR-segment depression) increased significantly (P =. 012) when the QRS and QT changes were added to the diagnostic algorithm. Conclusions Patients with acute STEMI, but not those with acute pericarditis, show prolongation of QRS complex and shortening of QT interval in ECG leads with ST-segment elevation. These new findings may improve the differential diagnostic yield of the classical ECG criteria. © 2014 Elsevier Inc. All rights reserved.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Myocardial infarction ; Pericarditis ; QRS complex ; QT interval ; ST segment
Published in:	American Journal of Medicine, Vol. 127 Núm. 3 (march 2014) , p. 233-239, ISSN 1555-7162

DOI: 10.1016/j.amjmed.2013.11.006
PMID: 24287008

7 p, 1.1 MB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles