Relationship between terminal QRS distortion on the admission electrocardiogram and the time course of left ventricular wall motion in anterior wall acute myocardial infarction

In order to clarify the time course of left ventricular (LV) wall motion in patients with anterior acute myocardial infarction (AMI) showing terminal QRS distortion on the admission electrocardiogram (ECG), the present study examined 106 patients with their first anterior AMI (less than or equal to6 h) who underwent emergency coronary arteriography and cardiac cathetheriza tion at 1 and 6 months after the infarction. The patients were classified i nto 2 groups according to the presence (group A, n=23) or absence (group B, n=83) of terminal QRS distortion (emergence of the J point at greater than or equal to 50% of the R-wave amplitude in leads with QR configuration and /or absence of S waves in leads with RS configuration) on the admission EGG . Group A had a lower LV ejection fraction and more reduced regional wall m otion (RWM) in the infarct region at both 1 and 6 months after AMI than gro up B. The degree of improvement in RWM between 1 and 6 months after AMI was less in group A than in group B (-0.1+/-0.5 vs 0.4+/-0.6 SD/chord, p<0.01) . This study indicates that patients with anterior AMI showing terminal QRS distortion on the admission ECG have more severely depressed LV wall motio n and less improvement in RWM in the infarct region in the healing stage, s uggesting that this sign is an indicator of severe myocardial damage.