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CLINICAL STUDIES

Electrocardiographic evolutionary changes and left ventricular remodeling after acute myocardial infarction¹

Results of the GISSI-3 Echo substudy

Enzo Bosimini, MD^*, Pantaleo Giannuzzi, MD^*, Pier L. Temporelli, MD^*, Francesco Gentile, MD, Donata Lucci, BS, Aldo P. Maggioni, MD, Luigi Tavazzi, MD, Luigi Badano, MD^||, Ioanna Stoian, MD^¶, Rita Piazza, MD^#, Ioanna Heyman, MD^**, Giacomo Levantesi, MD, Eugenio Cervesato, PhD^¶, Enrico Geraci, MD, Gian L. Nicolosi, MD^¶ for the GISSI-3 Echo Substudy Investigators

^* Fondazione Maugeri, Istituto Di Ricovero E Cura A Carattere Scientifico, Veruno, Italy
Ospedale Bassini, Cinisello Balsamo, Italy
Centro Studi Associazione Nazionale Medici Cardiologi Ospedalieri, Firenze, Italy
Ospedale S. Matteo, Pavia, Italy
^|| Ospedale Civile, Udine, Italy
^¶ Ospedale Civile, Pordenone, Italy
^# Ospedale Civile, S.Vito al Tagliamento, Italy
^** Ospedale Civile, Rho, Italy
Ospedale Civile, Vasto, Italy
Ospedale Cervello, Palermo, Italy

Manuscript received March 15, 1999; revised manuscript received July 8, 1999, accepted September 10, 1999.

Reprint requests and correspondence: Dr. Enzo Bosimini, "Salvatore Maugeri" Foundation, IRCCS; Division of Cardiology, Via Revislate, 13; 28010 Veruno (NO), Italy
ebosimini{at}fsm.it

OBJECTIVES

The aim of this study was to describe the electrocardiographic (ECG) evolutionary changes after an acute myocardial infarction (AMI) and to evaluate their correlation with left ventricular function and remodeling.

BACKGROUND

The QRS complex changes after AMI have been correlated with infarct size and left ventricular function. By contrast, the significance of T wave changes is controversial.

METHODS

We studied 536 patients enrolled in the GISSI-3-Echo substudy who underwent ECG and echocardiographic studies at 24 to 48 h (S1), at hospital discharge (S2), at six weeks (S3) and six months (S4) after AMI.

RESULTS

The number of Q waves (nQ) and QRS quantitative score (QRSs) did not change over time. From S2 to S4, the number of negative T waves (nT NEG) decreased (p < 0.0001), wall motion abnormalities (%WMA) improved (p < 0.001), ventricular volumes increased (p < 0.0001) while ejection fraction remained stable. According to the T wave changes after hospital discharge, patients were divided into four groups: stable positive T waves (group 1, n = 35), patients who showed a decrease 1 in nT NEG (group 2, n = 361), patients with no change in nT NEG (group 3, n = 64) and those with an increase 1 in nT NEG (group 4, n = 76). The QRSs and nQ remained stable in all groups. Groups 3 and 4 showed less recovery in %WMA, more pronounced ventricular enlargement and progressive decline in ejection fraction than groups 1 and 2 (interaction time x groups p < 0.0001).

CONCLUSIONS

The analysis of serial ECG can predict postinfarct left ventricular remodeling. Normalization of negative T waves during the follow-up appears more strictly related to recovery of regional dysfunction than QRS changes. Lack of resolution and late appearance of new negative T predict unfavorable remodeling with progressive deterioration of ventricular function.

Abbreviations and Acronyms   AMI = acute myocardial infarction   ECG = electrocardiographic   nQ = number of Q waves at 12-lead ECG   nT NEG = the number of negative T waves at 12-lead electrocardiogram   QRSs = quantitative QRS scoring system   %WMA = the percentage of wall motion abnormalities at echocardiographic study

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