title: Reduction of QTD--A Novel Marker of Successful Reperfusion in NSTEMI. Pathophysiologic Insights by CMR.
abstract: OBJECTIVE
  Non-ST segment elevation myocardial infarction (MI) poses similar detrimental long-term prognosis as ST-segment elevation MI. No marker on ECG is established to predict successful reperfusion in NSTEMI. QT dispersion is increased by myocardial ischemia and reduced by successful restoration of epicardial blood flow by PCI. Whether QT dispersion reduction translates to smaller infarcts and thus indicates successful reperfusion is unknown. We hypothesized that the relative reduction of QT dispersion (QTD-Rrel ) on a standard ECG in acutely reperfused NSTEMI is related to infarct size and infarct transmurality as assessed by delayed enhancement CMR (DE-CMR).
  
  
  RESULTS
  69 patients with a first acute NSTEMI were included. QTD-Rrel was stratified according to LV function and volumes, infarct transmurality and size as assessed by DE-CMR. Extensive myocardial infarction was defined as above median infarct size. LV function and end-systolic volume were only mildly related to QTD-Rrel . QTD-Rrel was inversely related to infarct size (r=-0.506,p=0.001) and infarct transmurality (r=-0.415, p=0.001). QTD-Rrel was associated with extensive myocardial infarction in univariate analysis (odds ratio (OR) 0.958, CI 0.935-0.982; p=0.001). Compared to clinical and angiographic data QTD-Rrel remained the only independent predictor of non-transmural infarcts (OR 1.110, CI 1.055-1.167; p=0.049).
  
  
  CONCLUSIONS
  In patients with acute Non-ST-Segment Myocardial infarction QTd-Rrel calculated on a surface ECG prior and post PCI for restoration of epicardial blood flow detects small, non-transmural infarcts as assessed by delayed enhancement CMR. Thus, QTd-Rrel can indicate successful reperfusion therapy.
authors.affiliation: 1. Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth Hospital Essen, Germany;
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Jensen
authors.affiliation: 1. Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth Hospital Essen, Germany;
authors.forename: Sarah
authors.initials: S
authors.lastname: Lusebrink
authors.affiliation: 1. Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth Hospital Essen, Germany;
authors.forename: Alexander
authors.initials: A
authors.lastname: Wolf
authors.affiliation: 2. Department of Diagnostic and Interventional Radiology and Neuroradiology, University of Essen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schlosser
authors.affiliation: 2. Department of Diagnostic and Interventional Radiology and Neuroradiology, University of Essen, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Nassenstein
authors.affiliation: 1. Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth Hospital Essen, Germany;
authors.forename: Christoph K
authors.initials: CK
authors.lastname: Naber
authors.affiliation: 1. Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth Hospital Essen, Germany;
authors.forename: Georg V
authors.initials: GV
authors.lastname: Sabin
authors.affiliation: 1. Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth Hospital Essen, Germany;
authors.forename: Oliver
authors.initials: O
authors.lastname: Bruder
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000503:physiopathology*; D015425:Myocardial Reperfusion; D016277:Ventricular Function, Left
keywords: QT dispersion; acute myocardial infarction; cardiac magnetic resonance imaging.; non-ST-elevation myocardial infarction