PMID- 35093624
OWN - NLM
STAT- MEDLINE
DCOM- 20220408
LR  - 20220408
IS  - 1532-8171 (Electronic)
IS  - 0735-6757 (Linking)
VI  - 54
DP  - 2022 Apr
TI  - Dynamic changes in electrocardiographic findings between initial and follow-up 
      electrocardiography: The role of the T/QRS ratio.
PG  - 8-14
LID - S0735-6757(22)00036-5 [pii]
LID - 10.1016/j.ajem.2022.01.033 [doi]
AB  - BACKGROUND: Dynamic changes in electrocardiographic findings between initial and 
      follow-up electrocardiograms (ECGs) have rarely been studied for disease severity 
      and differential diagnosis in non-ST elevation acute coronary syndrome. We aimed 
      to determine whether the changes in staple variables on ECG can assist in 
      distinguishing between neuropsychiatric or gastrointestinal disorders (mild 
      non-ischemic disorders), heart failure, and NSTE-ACS (non-ST elevation acute 
      coronary syndrome). METHODS: This retrospective study enrolled 1279 patients who 
      presented with ischemic symptoms; were diagnosed with NSTE-ACS, acute heart 
      failure, and mild disorders; and underwent echocardiography and coronary 
      angiography. After performing propensity matching of the ECG follow-up interval, 
      184 patients with symptom onset within 48 h were included and analyzed. RESULTS: 
      As a discriminator for NSTE-ACS, the maximum change in the T/QRS ratio in two 
      contiguous leads was superior to the maximum change in ST segment depression, T 
      wave inversion, and ST/T ratio. ECGs of patients with NSTE-ACS and heart failure 
      showed a tendency to increase and decrease the T/QRS ratio change, respectively. 
      Compared with regional wall motion abnormality, the change in troponin I/h and 
      the maximum change in ST segment depression and T-wave inversion, the most 
      deviated T/QRS ratio change from 1 (>1.5 or < 0.5) in two contiguous leads was 
      the most significant discriminator for disease severity and differential 
      diagnosis (standardized beta = 0.545, p < 0.001). CONCLUSION: The maximum changes in 
      the T/QRS ratio in two contiguous leads can assist in distinguishing disease 
      severity and acute mimicking disease such as acute heart failure in patients with 
      suspected ACS.
CI  - Copyright (c) 2022 Elsevier Inc. All rights reserved.
FAU - Choi, Yuri
AU  - Choi Y
AD  - Department of Emergency Medicine, Dong-A University College of Medicine, Busan, 
      Republic of Korea. Electronic address: yurichoi@dau.ac.kr.
FAU - Lee, Jae Hoon
AU  - Lee JH
AD  - Department of Emergency Medicine, Dong-A University College of Medicine, Busan, 
      Republic of Korea. Electronic address: leetoloc@dau.ac.kr.
LA  - eng
PT  - Journal Article
DEP - 20220121
PL  - United States
TA  - Am J Emerg Med
JT  - The American journal of emergency medicine
JID - 8309942
SB  - IM
MH  - *Acute Coronary Syndrome/diagnosis
MH  - Electrocardiography
MH  - Follow-Up Studies
MH  - *Heart Failure/diagnosis
MH  - Humans
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Acute coronary syndrome
OT  - Acute heart failure
OT  - Coronary angiography
OT  - Electrocardiography
COIS- Declaration of Competing Interest The authors declare that they have no conflict 
      of interest.
EDAT- 2022/01/31 06:00
MHDA- 2022/04/09 06:00
CRDT- 2022/01/30 20:30
PHST- 2021/11/19 00:00 [received]
PHST- 2022/01/02 00:00 [revised]
PHST- 2022/01/16 00:00 [accepted]
PHST- 2022/01/31 06:00 [pubmed]
PHST- 2022/04/09 06:00 [medline]
PHST- 2022/01/30 20:30 [entrez]
AID - S0735-6757(22)00036-5 [pii]
AID - 10.1016/j.ajem.2022.01.033 [doi]
PST - ppublish
SO  - Am J Emerg Med. 2022 Apr;54:8-14. doi: 10.1016/j.ajem.2022.01.033. Epub 2022 Jan 
      21.