Prediction of improvement in left ventricular function during a 1-year follow-up after acute myocardial infarction by the degree of acute resolution of electrocardiographic changes Egle Kalinauskiene, MD, DSc , a,b, * Albinas Naudziunas, MD, PhD, b Ramunas Navickas, MD, PhD, a Edvardas Vaicekavicius, MD, PhD, a Vidas Pilvinis, MD, DSc, c Laima Jankauskiene, MD, DSc, b Jone Vencloviene, DSc, a Ausra Bernotiene, MD b a Institute of Cardiology of Kaunas University of Medicine, LT-50009 Kaunas, Lithuania b Department of Internal Medicine of Kaunas University of Medicine, LT-50009 Kaunas, Lithuania c Department of Intensive Care of Kaunas University of Medicine, LT-50009 Kaunas, Lithuania Received 30 November 2006; accepted 11 May 2007 Abstract Background and Purpose: Reperfusion therapy results in better left ventricle (LV) function in cases of successful myocardial reperfusion; however, insufficient reperfusion or reocclusion of the infarct- related artery is associated with LV dysfunction. This study was proposed to determine whether the rate of ECG stage dynamics, after mechanical, thrombolytic, or spontaneous recanalization, is a predictor of improvement in LV function. Methods: Twenty-seven consecutive patients, observed for 1 year, were divided into group A (11, change rate of ≥2 ECG stages per 2 days), group B (13, no rapid change), and cases with reocclusion (3). Results: Clinical and radiographic signs of heart failure tended to decrease in group A but tended to increase in other cases. Echocardiographic dyssynergic score decreased, and LV ejection fraction increased only in group A: 4.3 ± 1.2 vs 2.7 ± 1.5, P = .04, and 42.0 ± 4.8 vs 46.0 ± 8.3, P = .049, respectively; in group B, the values were 3.4 ± 2.4 vs 3.4 ± 2.2 and 44.0 ± 6.9 vs 43.8 ± 9.3, respectively. Conclusions: Rapid ECG stage changes predict follow-up improvement in LV function. © 2007 Elsevier Inc. All rights reserved. Keywords: Electrocardiogram; Myocardial infarction; Reperfusion therapy; Markers of reperfusion; Left ventricular function Introduction Myocardial reperfusion therapy results in better function of the left ventricle (LV) and improved survival after acute myocardial infarction (AMI) in cases of early and successful recanalization of the infarct-related artery (IRA) and sufficient myocardial reperfusion. 1,2 However, late recanalization (3 or more days after AMI) or insufficient myocardial reperfusion is associated with a lower LV ejection fraction 3,4 and an increased risk of death. Ito et al 5,6 demonstrated that restoration of normal epicardial blood flow is not sufficient to ensure adequate myocardial reperfusion; the latter requires perfusion at the level of the coronary microcirculation and myocytes. ST resolution after reperfusion therapy was shown as an excellent predictor of prognosis and recovery of LV function: the ST-segment resolution patterns were predictive for the combined outcome of mortality and heart failure, whereas thrombolysis in myocardial infarction (MI) flow (the distal flow in the IRA after reperfusion therapy assessed by angiography) grade was not. 7-9 ST reelevation was used to detect coronary reocclusion. 10 However, some studies suggest that early inversion of T wave after thrombolytic therapy is a better marker of reperfusion and a better prognostic indicator of improved outcome in patients with AMI than is ST resolution. 11 In the prethrombolytic era, it was shown that the Selvester QRS score measures infarct size, with each of the 32 points in the score corresponding to approximately 3% of the LV mass. 12 QRS score is also Journal of Electrocardiology 40 (2007) 416 – 421 www.jecgonline.com ⁎ Corresponding author. Kaunas University of Medicine, LT-50009 Kaunas, Lithuania. Tel.: +370 37 306093; fax: +370 37 306093. E-mail address: eglekalin@yahoo.com 0022-0736/$ – see front matter © 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.jelectrocard.2007.05.007