Profound Anterior ST-Segment Elevation in a Patient with Lung Cancer and Echocardiographic Evidence of Right Ventricle Metastasis.
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ABSTRACT:
SUBMITTER: Xu J
PROVIDER: S-EPMC9050599 | biostudies-literature | 2022 Apr
REPOSITORIES: biostudies-literature
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Profound Anterior ST-Segment Elevation in a Patient with Lung Cancer and Echocardiographic Evidence of Right Ventricle Metastasis.
Xu Jianping J Cui Faping F Wang Dandan D Liu Jili J Zhou Ruihai R
CASE (Philadelphia, Pa.) 20211229 2
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Project description:BackgroundWhen compared to left ventricular ejection fraction (LVEF), previous studies have suggested the superiority of wall motion score index (WMSI) in predicting cardiac events in patients who have suffered acute myocardial infarction. However, there are limited studies assessing WMSI and mortality in ST-segment elevation myocardial infarction (STEMI). We aimed to compare the prognostic value of WMSI in a cohort of STEMI patients treated with primary percutaneous coronary intervention (PCI).MethodsA comparison of WMSI, LVEF, and all-cause mortality in STEMI patients treated with primary PCI between January 2008 and December 2020 was performed. The prognostic value of WMSI, LVEF, and traditional risk scores (TIMI, GRACE) were compared using multivariable logistic regression modelling.ResultsAmong 1181 patients, 27 died within 30-days (2.3%) and 49 died within 12 months (4.2%). WMSI ≥1.8 was associated with poorer survival at 12-months (9.2% vs 1.5%; p < 0.001). When used as the only classifier for predicting 12-month mortality, the discriminatory ability of WMSI (area under the curve (AUC): 0.77; 95% CI: 0.68-0.84) was significantly better than LVEF (AUC: 0.71; 95% CI: 0.61-0.79; p=0.034). After multivariable modelling, the AUC was comparable between models with either WMSI (AUC: 0.89; 95% CI: 0.85-0.94) or LVEF (AUC: 0.87; 95% CI: 0.83-0.92; p < 0.08) yet performed significantly better than TIMI (AUC: 0.71; 95% CI: 0.62-0.79; p < 0.001), or GRACE (AUC: 0.63; 95% CI: 0.54-0.71; p < 0.001) risk scores.ConclusionsWhen examined individually, WMSI is a superior predictor of 12-month mortality over LVEF in STEMI patients treated with primary PCI. When examined in multivariable predictive models, WMSI and LVEF perform very well at predicting 12-month mortality, especially when compared to existing STEMI risk scores.
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Project description:Background: Right ventricular (RV) infarction is as an extremely rare cause of isolated anterior ST-segment elevation. Occlusion of the RV branch in a recessive right coronary artery (RCA) causing isolated RV infarction and only anterior ST-elevation is extremely rare. To date, the handful of such cases reports do not describe any arrhythmia associated with this presentation. Although ventricular fibrillation (VF) has been well-documented with interruption of flow in the conus branch of the RCA, here we describe VF occurring in a patient with occlusion of the RV branch of a recessive RCA presenting with isolated anterior ST-segment elevation. Case: A 51-year-old man presented with acute chest pain and isolated anterior ST-segment elevation on electrocardiogram (ECG). The patient developed ventricular fibrillation prior to coronary angiography requiring cardiopulmonary resuscitation. Coronary angiography revealed an unobstructed left coronary system and a recessive right coronary artery with ostial occlusion of the RV branch which was treated with a drug eluting balloon, resulting in resolution of the chest pain and ECG changes. Conclusion: Isolated RV infarction due to RV branch occlusion can cause ECG changes mimic anterior left ventricular infarction. This presentation may be complicated by VF, even in the setting of a recessive RCA.
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Project description:Patients with secondary cardiac cancer occasionally show ST segment elevation that mimics acute coronary syndrome despite the absence of coronary artery occlusion. We herein describe a rare case of secondary cardiac cancer that presented with ST-segment elevation. An 82-year-old Chinese man was admitted to the hospital with chest discomfort. Electrocardiography (ECG) showed ST segment elevation in the precordial leads and low-voltage QRS complexes in limb leads without the development of Q waves. Unexpectedly, emergency coronary angiography showed no significant stenosis of the coronary arteries. However, fortunately, transthoracic echocardiography (TTE) revealed massive pericardial effusion and a mass at the apex of the ventricular myocardium. Coincidentally, contrast-enhanced chest computed tomography showed primary lung cancer in the left lower lobe, pericardial effusion, and myocardial metastasis at the ventricular apex. The pericardiac fluid contained blood with significantly increased CEA levels and exfoliated tumor cells. The lung histopathological report suggested squamous cell carcinoma. Two months later, the patient died. These findings suggested that the persistent ST-segment without the development of Q waves was associated with ventricular invasion by primary lung cancer and may indicate a poor prognosis. In conclusion, physicians should be aware of persistent ST-segment elevation mimicking myocardial infarction due to cardiac metastasis with a poor prognosis.
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