Diagnosis of ventricular aneurysm and other severe segmental left ventricular dysfunction consequent to a myocardial infarction in the presence of right bundle branch block: ECG correlates of a positive diagnosis made via echocardiography and/or contrast ventriculography

John E. Madias, Ramin Ashtiani, Himanshu Agarwal, Virenjan K. Narayan, Moethu Win, Anjan Sinha

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: A diagnostic ECG sign of a ventricular aneurysm (VA) consequent to a myocardial infarction (MI) in the presence of complete left bundle branch block was recently described, and consists of the presence of ST-segment elevation (+ST), instead of the expected ST-segment depression (-ST), in leads V4-6. Generally, complete right bundle branch block (RBBB) is associated with -ST in ECC leads V1-3. We hypothesized that stable +ST, instead of the expected -ST in leads V1-3 in patients with RBBB could be also diagnostic of a VA and other severe segmental left ventricular dysfunction (VA/SSD). Thus, this study was performed to explore the feasibility of using the ECG to diagnose a VA/SSD in the presence of RBBB, and to evaluate the determinants of such diagnosis. Methods: The frequency of +ST ≥1 mm in leads V1-3 was assessed in patients with RBBB, prior MI, and a VA/SSD diagnosed by echocardiography and/or contrast left cine-ventriculography. The ECC correlates for a positive or negative diagnosis of a VA/SSD were explored. Results: Out of 4197 files of our cohort of the Cardiology Clinic, RBBB was detected in 175 patients. Of these, 28 had an old MI, and had a VA/SSD diagnosed by ≥1 of noninvasive and/or invasive non-ECG tests. Twenty-one of these 28 patients had stable +ST in ≥1 of leads V1-3 (Group 1), and 7 did not (Group 2). Thus, the sensitivity of this ECG criterion for the diagnosis of VA/SSD was 75%, and the specificity was 100% in this highly selective group. VA/SSD in the septal and anterior myocardial regions was more frequent in the patients of Group 1, than in the patients of Group 2 (P = 0.03 and 0.02, correspondingly). The number of myocardial territories involved with the VA/SSD, or the ejection fraction were not different in the two groups (P = 0.65 and 0.55, correspondingly). Conclusion: VA/SSD can be diagnosed in the presence of RBBB by the concordant to the QRS repolarization changes (+ST) in leads V 1-3. Positivity of this ECG marker for VA/SSD correlates with involvement of the septal or anterior myocardial regions, and represents mechanistically a superimposition of primary repolarization alterations, overcoming the secondary such changes.

Original languageEnglish (US)
Pages (from-to)53-59
Number of pages7
JournalAnnals of Noninvasive Electrocardiology
Volume10
Issue number1
DOIs
StatePublished - Jan 2005
Externally publishedYes

Fingerprint

Bundle-Branch Block
Silver Sulfadiazine
Left Ventricular Dysfunction
Aneurysm
Echocardiography
Electrocardiography
Myocardial Infarction
Patient Rights
Cardiology

Keywords

  • Contrast ventriculography
  • Echocardiography
  • Electrocardiography
  • Right bundle branch block
  • Severe segmental left ventricular dysfunction
  • Ventricular aneurysm

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{45be990495e549719fd9f9a16f7ba0a3,
title = "Diagnosis of ventricular aneurysm and other severe segmental left ventricular dysfunction consequent to a myocardial infarction in the presence of right bundle branch block: ECG correlates of a positive diagnosis made via echocardiography and/or contrast ventriculography",
abstract = "Background: A diagnostic ECG sign of a ventricular aneurysm (VA) consequent to a myocardial infarction (MI) in the presence of complete left bundle branch block was recently described, and consists of the presence of ST-segment elevation (+ST), instead of the expected ST-segment depression (-ST), in leads V4-6. Generally, complete right bundle branch block (RBBB) is associated with -ST in ECC leads V1-3. We hypothesized that stable +ST, instead of the expected -ST in leads V1-3 in patients with RBBB could be also diagnostic of a VA and other severe segmental left ventricular dysfunction (VA/SSD). Thus, this study was performed to explore the feasibility of using the ECG to diagnose a VA/SSD in the presence of RBBB, and to evaluate the determinants of such diagnosis. Methods: The frequency of +ST ≥1 mm in leads V1-3 was assessed in patients with RBBB, prior MI, and a VA/SSD diagnosed by echocardiography and/or contrast left cine-ventriculography. The ECC correlates for a positive or negative diagnosis of a VA/SSD were explored. Results: Out of 4197 files of our cohort of the Cardiology Clinic, RBBB was detected in 175 patients. Of these, 28 had an old MI, and had a VA/SSD diagnosed by ≥1 of noninvasive and/or invasive non-ECG tests. Twenty-one of these 28 patients had stable +ST in ≥1 of leads V1-3 (Group 1), and 7 did not (Group 2). Thus, the sensitivity of this ECG criterion for the diagnosis of VA/SSD was 75{\%}, and the specificity was 100{\%} in this highly selective group. VA/SSD in the septal and anterior myocardial regions was more frequent in the patients of Group 1, than in the patients of Group 2 (P = 0.03 and 0.02, correspondingly). The number of myocardial territories involved with the VA/SSD, or the ejection fraction were not different in the two groups (P = 0.65 and 0.55, correspondingly). Conclusion: VA/SSD can be diagnosed in the presence of RBBB by the concordant to the QRS repolarization changes (+ST) in leads V 1-3. Positivity of this ECG marker for VA/SSD correlates with involvement of the septal or anterior myocardial regions, and represents mechanistically a superimposition of primary repolarization alterations, overcoming the secondary such changes.",
keywords = "Contrast ventriculography, Echocardiography, Electrocardiography, Right bundle branch block, Severe segmental left ventricular dysfunction, Ventricular aneurysm",
author = "Madias, {John E.} and Ramin Ashtiani and Himanshu Agarwal and Narayan, {Virenjan K.} and Moethu Win and Anjan Sinha",
year = "2005",
month = "1",
doi = "10.1111/j.1542-474X.2005.00590.x",
language = "English (US)",
volume = "10",
pages = "53--59",
journal = "Annals of Noninvasive Electrocardiology",
issn = "1082-720X",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Diagnosis of ventricular aneurysm and other severe segmental left ventricular dysfunction consequent to a myocardial infarction in the presence of right bundle branch block

T2 - ECG correlates of a positive diagnosis made via echocardiography and/or contrast ventriculography

AU - Madias, John E.

AU - Ashtiani, Ramin

AU - Agarwal, Himanshu

AU - Narayan, Virenjan K.

AU - Win, Moethu

AU - Sinha, Anjan

PY - 2005/1

Y1 - 2005/1

N2 - Background: A diagnostic ECG sign of a ventricular aneurysm (VA) consequent to a myocardial infarction (MI) in the presence of complete left bundle branch block was recently described, and consists of the presence of ST-segment elevation (+ST), instead of the expected ST-segment depression (-ST), in leads V4-6. Generally, complete right bundle branch block (RBBB) is associated with -ST in ECC leads V1-3. We hypothesized that stable +ST, instead of the expected -ST in leads V1-3 in patients with RBBB could be also diagnostic of a VA and other severe segmental left ventricular dysfunction (VA/SSD). Thus, this study was performed to explore the feasibility of using the ECG to diagnose a VA/SSD in the presence of RBBB, and to evaluate the determinants of such diagnosis. Methods: The frequency of +ST ≥1 mm in leads V1-3 was assessed in patients with RBBB, prior MI, and a VA/SSD diagnosed by echocardiography and/or contrast left cine-ventriculography. The ECC correlates for a positive or negative diagnosis of a VA/SSD were explored. Results: Out of 4197 files of our cohort of the Cardiology Clinic, RBBB was detected in 175 patients. Of these, 28 had an old MI, and had a VA/SSD diagnosed by ≥1 of noninvasive and/or invasive non-ECG tests. Twenty-one of these 28 patients had stable +ST in ≥1 of leads V1-3 (Group 1), and 7 did not (Group 2). Thus, the sensitivity of this ECG criterion for the diagnosis of VA/SSD was 75%, and the specificity was 100% in this highly selective group. VA/SSD in the septal and anterior myocardial regions was more frequent in the patients of Group 1, than in the patients of Group 2 (P = 0.03 and 0.02, correspondingly). The number of myocardial territories involved with the VA/SSD, or the ejection fraction were not different in the two groups (P = 0.65 and 0.55, correspondingly). Conclusion: VA/SSD can be diagnosed in the presence of RBBB by the concordant to the QRS repolarization changes (+ST) in leads V 1-3. Positivity of this ECG marker for VA/SSD correlates with involvement of the septal or anterior myocardial regions, and represents mechanistically a superimposition of primary repolarization alterations, overcoming the secondary such changes.

AB - Background: A diagnostic ECG sign of a ventricular aneurysm (VA) consequent to a myocardial infarction (MI) in the presence of complete left bundle branch block was recently described, and consists of the presence of ST-segment elevation (+ST), instead of the expected ST-segment depression (-ST), in leads V4-6. Generally, complete right bundle branch block (RBBB) is associated with -ST in ECC leads V1-3. We hypothesized that stable +ST, instead of the expected -ST in leads V1-3 in patients with RBBB could be also diagnostic of a VA and other severe segmental left ventricular dysfunction (VA/SSD). Thus, this study was performed to explore the feasibility of using the ECG to diagnose a VA/SSD in the presence of RBBB, and to evaluate the determinants of such diagnosis. Methods: The frequency of +ST ≥1 mm in leads V1-3 was assessed in patients with RBBB, prior MI, and a VA/SSD diagnosed by echocardiography and/or contrast left cine-ventriculography. The ECC correlates for a positive or negative diagnosis of a VA/SSD were explored. Results: Out of 4197 files of our cohort of the Cardiology Clinic, RBBB was detected in 175 patients. Of these, 28 had an old MI, and had a VA/SSD diagnosed by ≥1 of noninvasive and/or invasive non-ECG tests. Twenty-one of these 28 patients had stable +ST in ≥1 of leads V1-3 (Group 1), and 7 did not (Group 2). Thus, the sensitivity of this ECG criterion for the diagnosis of VA/SSD was 75%, and the specificity was 100% in this highly selective group. VA/SSD in the septal and anterior myocardial regions was more frequent in the patients of Group 1, than in the patients of Group 2 (P = 0.03 and 0.02, correspondingly). The number of myocardial territories involved with the VA/SSD, or the ejection fraction were not different in the two groups (P = 0.65 and 0.55, correspondingly). Conclusion: VA/SSD can be diagnosed in the presence of RBBB by the concordant to the QRS repolarization changes (+ST) in leads V 1-3. Positivity of this ECG marker for VA/SSD correlates with involvement of the septal or anterior myocardial regions, and represents mechanistically a superimposition of primary repolarization alterations, overcoming the secondary such changes.

KW - Contrast ventriculography

KW - Echocardiography

KW - Electrocardiography

KW - Right bundle branch block

KW - Severe segmental left ventricular dysfunction

KW - Ventricular aneurysm

UR - http://www.scopus.com/inward/record.url?scp=16444375108&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=16444375108&partnerID=8YFLogxK

U2 - 10.1111/j.1542-474X.2005.00590.x

DO - 10.1111/j.1542-474X.2005.00590.x

M3 - Article

C2 - 15649238

AN - SCOPUS:16444375108

VL - 10

SP - 53

EP - 59

JO - Annals of Noninvasive Electrocardiology

JF - Annals of Noninvasive Electrocardiology

SN - 1082-720X

IS - 1

ER -