The Prognostic Value Of T Wave Shape Of Lead AVR In Patients With Acute Anterior Wall Myocardial Infarction

Objective To explore the value of T wave shape of lead aVR in evaluating the condition and short-term prognosis of patients with acute anterior wall myocardial infarction.Methods A total of 322 patients?mean age 59.10 years,271 males and 51 females?with acute anterior ST segment elevation myocardial infarction,concurrent emergency CAG and PCI admitted to the General Hospital of Ningxia Medical University from August 2017 to December 2018 were analyzed retrospectively.To collect the ECG of eligible patients before operation.According to the T wave shape in aVR lead,the patients were divided into T-wave upright group?T wave amplitude?0.1mv?and T-wave non upright group?T wave amplitude<0.1mv,including low flat,negative wave,negative positive and negative two-way or positive and negative two-way?.After grouping,the general data of patients were collected,and some hematology index:WBC,RBC,HGB,PLT,CREA,CK,TC,TG,HDL-C,HCY,Hs-CRP,pro-BNP and cTnI were detected;LVEF,LVEDD,LVESD,LVFS,and the abnormal position of wall segment movement in color Doppler echocardiography,coronary artery lesions during operation,and Gensini score was calculated according to CAG.As well as the incidence of cardiovascular adverse events during hospitalization,hospitalization days and other data.SPSS22.0 software was used for statistical analysis,and the difference was statistically significant when P?0.05.Results1.Comparison of general data and related hematological indexes between the two groups:The patients of T-wave upright group were older than that of T-wave non upright group?T-wave upright group 61.21�12.94 years old,T-wave non upright group57.41�11.87years old,P value 0.008?,the levels of WBC and CRP were higher in the T-wave upright group than those of T-wave non upright group(T-wave upright group WBC 11.29�3.83*10⁹/L,Hs-CRP 22.11�30.06mg/L,T-wave non upright group WBC 10.39�2.91*10⁹/L,Hs-CRP 12.98�17.22mg/L,P value 0.031 and 0.001),the differences between the two groups were statistically significant?P?0.05?.2.Comparison of cardiac function between the two groups:In T-wave upright group the pro-BNP was higher?T-wave upright group 2091.14�3030.86ng/l,T-wave non upright group1051.24�1818.32ng/l,P value 0.000?,LVEF was lower?T-wave upright group 46.92%�7.24%,T-wave non upright group 51.13%�8.07%,P value 0.000?,LVEDD was larger?T-wave upright group 52.80�5.34mm,T-wave non upright group 50.51�4.67mm in,P value0.000?,LVESD was larger?T-wave upright group 40.27�5.49mm,T-wave non upright group37.24�5.12mm,P value 0.000?,LVFS was smaller?T-wave upright group23.93%�4.28%,T-wave non upright group 26.36%�5.10%,P value 0.000?,the differences between the two groups were statistically significant?P?0.05?.3.The number of infarct sites,the number of coronary lesions and Gensini scores were compared between the two groups:the proportion of infarction in?two parts of T-wave upright group was higher?68 in T-wave upright group,accounting for 60.71%;89 in T-wave non upright group,accounting for 42.38%,P value 0.004?,the proportion of coronary multi vessel lesions was higher?94 in the T-wave upright group,accounting for 83.93%;89 in the T-wave non upright group,accounting for 69.05%,P value 0.000?,the proportion of Gensini score?60 was higher?67 in the T-wave upright group,accounting for 59.82%;94 in the T-wave non upright group,accounting for 45.24%,P value 0.035?,the differences between the two groups were statistically significant?P?0.05?.4.Comparison of hospitalization days and adverse cardiovascular events in the two groups:the length of hospitalization days was longer in T-wave upright group?T-wave upright group 10.79�5.60 days,T-wave non upright group 8.75�2.76,P value 0.000?,the incidence of adverse events in hospital was higher?41 in the T-wave upright group,accounting for 36.61%;49 in the T-wave non upright group,accounting for 23.33%,P value 0.011?,the differences between the two groups were statistically significant?P?0.05?.5.The T-wave upright of lead aVR is an independent risk factor for MACE in hospital,myocardial infarction at two or more sites,and Gensini score?60.ConclusionPatients with acute anterior wall myocardial infarction were more seriously ill and had worse prognosis in the group of T-wave upright of aVR lead of bedside ECG at the moment of admission.