Diagnostic and Prognostic Value of the V-index, a novel ECG marker quantifying Spatial Heterogeneity of Ventricular Repolarization, in Patients with Symptoms suggestive of Non-ST-Elevation Myocardial Infarction
Articolo
Data di Pubblicazione:
2017
Citazione:
Diagnostic and Prognostic Value of the V-index, a novel ECG marker quantifying Spatial Heterogeneity of Ventricular Repolarization, in Patients with Symptoms suggestive of Non-ST-Elevation Myocardial Infarction / R. Abächerli, R. Twerenbold, J. Boeddinghaus, T. Nestelberger, P. Maechler, R. Sassi, M.W. Rivolta, A. Kheirati Roonizi, L.T. Mainardi, N. Kozhuharov, M.R. Giménez, K. Wildi, K. Grimm, Z. Sabti, P. Hillinger, C. Puelacher, I. Strebel, J. Cupa, P. Badertscher, I. Roux, R. Schmid, R. Leber, S. Osswald, C. Mueller, T. Reichlin. - In: INTERNATIONAL JOURNAL OF CARDIOLOGY. - ISSN 0167-5273. - 236:(2017), pp. 23-29. [10.1016/j.ijcard.2017.01.151]
Abstract:
The V-index is an ECG marker quantifying spatial heterogeneity of ventricular repolarization. We prospectively assessed the diagnostic and prognostic values of the V-index in patients with suspected non-ST-elevation myocardial infarction (NSTEMI).
METHODS:
We prospectively enrolled 497 patients presenting with suspected NSTEMI to the emergency department (ED). Digital 12-lead ECGs of five-minute duration were recorded at presentation. The V-index was automatically calculated in a blinded fashion. Patients with a QRS duration >120ms were ruled out from analysis. The final diagnosis was adjudicated by two independent cardiologists. The prognostic endpoint was all-cause mortality during 24months of follow-up.
RESULTS:
NSTEMI was the final diagnosis in 14% of patients. V-index levels were higher in patients with AMI compared to other causes of chest pain (median 23ms vs. 18ms, p<0.001). The use of the V-index in addition to conventional ECG-criteria improved the diagnostic accuracy for the diagnosis of NSTEMI as quantified by area under the ROC curve from 0.66 to 0.73 (p=0.001) and the sensitivity of the ECG for AMI from 41% to 86% (p<0.001). Cumulative 24-month mortality rates were 99.4%, 98.4% and 88.3% according to tertiles of the V-index (p<0.001). After adjustment for age and important ECG and clinical parameters, the V-index remained an independent predictor of death.
CONCLUSIONS:
The V-index, an ECG marker quantifying spatial heterogeneity of ventricular repolarization, significantly improves the accuracy and sensitivity of the ECG for the diagnosis of NSTEMI and independently predicts mortality during follow-up.
Tipologia IRIS:
01 - Articolo su periodico
Elenco autori:
R. Abächerli, R. Twerenbold, J. Boeddinghaus, T. Nestelberger, P. Maechler, R. Sassi, M.W. Rivolta, A. Kheirati Roonizi, L.T. Mainardi, N. Kozhuharov, M.R. Giménez, K. Wildi, K. Grimm, Z. Sabti, P. Hillinger, C. Puelacher, I. Strebel, J. Cupa, P. Badertscher, I. Roux, R. Schmid, R. Leber, S. Osswald, C. Mueller, T. Reichlin
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