PROGNOSTIC SIGNIFICANCE OF LOW QRS VOLTAGE ON THE ADMISSION ELECTROCARDIOGRAM IN ACUTE CORONARY SYNDROMES

Authors

  • Swara A. Mawlood Department of Cardiology, Sulaimani Teaching Hospital, Interventional Cardiology Center, Kurdistan Region, Iraq.
  • Farman J. Ahmed Department of Cardiology, Sulaimani Teaching Hospital, Interventional Cardiology Center, Kurdistan Region, Iraq.
  • Amar Talib Al-Hamdi Consultant Cardiologist and Electrophysiologist, Sulaimani, Kurdistan Region, Iraq.
  • Mohammad M. Arif Department of Cardiology, Sulaimani Teaching Hospital, Interventional Cardiology Center, Kurdistan Region, Iraq.

DOI:

https://doi.org/10.17656/jsmc.10350

Keywords:

Acute Myocardial Infarction, Low QRS Complex, Electrocardiography

Abstract

Background 

Myocardial infarction is one of the most common causes of mortality in middle and older age groups, especially in ventricular arrhythmia. Patients will be identified as having low QRS Voltage when peak-to-peak QRS complex voltage is less than 0.5 mV in all limb leads and less than 1.0 mV in all precordial leads.

Objectives 

To find the correlation between low QRS voltage in the hospital and one-month outcome of patients presenting with the acute coronary syndrome.

Patients and Methods

A prospective longitudinal study was performed on 400 patients admitted with the confirmed acute coronary syndrome and underwent percutaneous coronary intervention.

Results

The mean age was 61. ± 11.8years ranged from 22 to 90 years. Male was 67.8%, and 32.3% were female. The percentage of hypertension, diabetes mellitus, and previous myocardial infarction were 66.3%, 32.8% and 12.3%, respectively. Low QRS voltage was found in 17 patients (4.3%). Most of our patients (43.5%) had an anterior myocardial infarction, of which the culprit lesion was the Left Anterior Descending artery. An ejection fraction of more than 50% on echocardiography was found in 68.3% of them; additionally, 84.7% had a Killip Class of one. Therefore, in-hospital death was 4.8%. Furthermore, the total death from admission to a month post-myocardial infarction was 9%. Fourteen patients had re-admission within that period for cardiac events. 

Conclusion

Low QRS in presenting electrocardiogram patients with the acute coronary syndrome will be significantly associated with hospital and one-month morbidity and mortality.

References

Roffi M, Patrono C, Collet JP; ESC Scientific DocumentGroup. 2015 ESC guidelines for managing acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of AcuteCoronary Syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology(ESC). Eur Heart J. 2016;37:267-315. DOI: https://doi.org/10.1093/eurheartj/ehv320

David D, Naito M, Chen CC, Michelson EL, Morganroth J. R-wave amplitude variations during acute experimental myocardial ischemia: an inadequate index for changes in intracardiac volume. Circulation. 1981,63: 1364–1371. DOI: https://doi.org/10.1161/01.CIR.63.6.1364

Sinno MC, Kowalski M, Kenigsberg DN, Krishnan SC, Khanal S. R-wave amplitude changes measured by electrocardiography during early transmural ischemia. J Electrocardiol. 2008; 41(5): 425–430. DOI: https://doi.org/10.1016/j.jelectrocard.2007.12.008

Isobe S, Okada M, Ando A, Nanasato M, Nonokawa M, Clinical significance of changes in electrocardiographic R-wave voltage on chest leads in patients with acute anterior myocardial infarction. J Electrocardiol. ,2002; 35: 173–180. DOI: https://doi.org/10.1054/jelc.2002.33761

DePace NL, Colby J, Hakki AH, Manno B, Horowitz LN. Poor R wave progression in the precordial leads: clinical implications for the diagnosis of myocardial infarction. J Am Coll Cardiol, 1983; 2: 1073–1079. DOI: https://doi.org/10.1016/S0735-1097(83)80332-5

Fox KM, Tomlinson IW, Meek DR, Portal RW, Aber CP. Low voltage electrocardiogram after acute myocardial infarction. Br Heart J. 1975; 37(7):748-51. DOI: https://doi.org/10.1136/hrt.37.7.748

Isobe S, Takada Y, Ando A, Ohshima S, Yamada K, Nanasato M, et al. Increase in electrocardiographic R-waves after revascularization in patients with acute myocardial infarction. Circ J. 2006; 70(11):1385–1391. DOI: https://doi.org/10.1253/circj.70.1385

Rotmensch HH, Meytes I, Terdiman R, Laniado S. Incidence and significance of the low-voltage electrocardiogram in acute myocardial infarction. Chest. 1977; 71(6):708–711. DOI: https://doi.org/10.1378/chest.71.6.708

Wearn JT. Thrombosis of the coronary arteries with infarction of the heart. Am J Med Sci. 1923; 165:250–264. DOI: https://doi.org/10.1097/00000441-192302000-00008

Kurisu S, Iwasaki T, Watanabe N, Ikenaga H, Shimonaga T, Higaki T, et al. Poor R-wave progression and myocardial infarct size after anterior myocardial infarction in the coronary intervention era. Int J Cardiol Heart Vasc. 2015; 7:106-9. DOI: https://doi.org/10.1016/j.ijcha.2014.09.002

Tan NS, Goodman SG, Yan RT, Tan MK, Fox KA, Gore JM, et al. Prognostic significance of low QRS voltage on the admission electrocardiogram in acute coronary syndromes. Int J Cardiol. 2015; 190:34-9. DOI: https://doi.org/10.1016/j.ijcard.2015.04.085

Kobayashi A, Misumida N, Aoi S, Kanei Y. Low QRS Voltage on Presenting Electrocardiogram Predicts Multi-vessel Disease in Anterior ST-segment Elevation Myocardial Infarction. J Electrocardiol. 2017; 50(6):870-875. DOI: https://doi.org/10.1016/j.jelectrocard.2017.06.012

Kiatchoosakun S, Wongwipaporn C, Pussadhamma B. Prognostic factors of in-hospital mortality in all comers with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Heart Asia. 2016; 8(2):13-7. DOI: https://doi.org/10.1136/heartasia-2015-010715

Published

2022-06-21

How to Cite

1.
Mawlood S, Ahmed F, Al-Hamdi A, Arif M. PROGNOSTIC SIGNIFICANCE OF LOW QRS VOLTAGE ON THE ADMISSION ELECTROCARDIOGRAM IN ACUTE CORONARY SYNDROMES. JSMC [Internet]. 2022 Jun. 21 [cited 2024 Jul. 20];12(2):113-8. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10350

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