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    Glucose-insulin-potassium therapy and its effects on signal-averaged electrocardiography in acute myocardial infarction
    (2000) Ulgen M.S.; Iltimur K.; Karadede A.; Alan S.; Toprak N.
    Low amplitude signals (LP) at the end of the QRS in patients with acute myocardial infarction (AMI) are related to fragmentation of the electrical impulse in ventricular myocardium and detected on signal-averaged electrocardiography. In this study, we investigated the use of glucose- insulin-potassium (GIK) solution and its effects on the SAECG in AMI. Methods: Seventy-two consecutive patients diagnosed with first Q-wave AMI were prospectively studied. Thrombolytic therapy was given to all patients unless contraindicated. The patients were randomly given glucose-insulin- potassium (GIK, n=34) solutions which consisted of 300 g of glucose, 50 units of insulin and 80 mEq of KCl in 1000 cc water placebo (saline, n.38). Ambulatory electrocardiographic examinations were performed in all patients between 24-48th hours. Sub-maximal exercise testing (if not contraindicated), signal-averaged electrocardiogram (SAECG) and echocardiographic records were obtained before discharge (6-9, mean 7 days). In postdischarge early period (in 30-40 days after index infarction) SAECG and echocardiography recordings were repeated. Results: There were no differences found between both groups in view of ages, number of risk factors, localization of infarction. In pre- discharge evaluations total filtered QRS duration (FQRS1: 103±7 msec vs 108±11 msec p<0.05), low-amplitude terminal signal duration (HFLA1: 25±8 msec vs 32±11 msec, p<0.01) and frequency of VLP1 (%20 vs %45 p<0.05) were found to be lower while root mean square voltage of the terminal 40 msec of the QRS (RMS-401: 45±18?V vs 36±20?V p<0.05), left ventricle ejection fraction (EF: 54±9 vs 48±8, p<0.05) to be higher in GIK when compared with the placebo group. In post discharge evaluations, FQRS2 (105±8 vs 110±10, p=0.05), HFLA2 (26±7 vs 34±10, p<0.01) and frequency of VLP2, (%25 vs %38, p>0.05) were found to be lower while RMS-402 (47±21 vs 33±19 p<0.05) and EF2 (59±10 vs 52±11, p<0.05) were higher in the GIK compared with the placebo group. The incidence of post-MI angina pectoris was significantly lower in the GIK-administered group (p<0.005) than in the placebo groups. The incidence of premature ventricular contraction was insignificantly lower in the GIK-administrated group (p>0.05). We concluded that using GIK solutions at the early stages of AMI may be beneficial on the SAECG, angina incidence, and left ventricular systolic performance in the pre-and postdischarge early period of AMI.
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    Öğe
    The relation between infarction localization and late potentials
    (2001) Iltümür K.; Karabulut A.; Temamogullari A.V.; Karadede A.; Alan S.; Siddik Ulgen M.; Toprak N.
    OBJECTIVE: There are controversies about the relation between infarction localization and late potentials (LP) following acute myocardial infarction (AMI). To evaluate this issue 124 consecutive patients with first Q-wave AMI fulfilling the inclusion criteria were enrolled in this signal--averaged ECG (SAECG) study. METHODS: The patients were divided into three groups according to infarction localization: anterior (Group I n = 62; 50%), inferior (Group II: n = 42; 34%) and both inferior and right ventricular (RV) involvement (Group III n = 20; 16%). SAECG records were performed during the second week. LP results were evaluated as positive when at least two of the major criteria (QRS > 114 ms, LAS 40 > 38 ms, RMS < 20 V) were obtained. Tukey--Cramer multivariate analysis was performed. RESULTS: Positive LP results were obtained in 29% of group I, 35.7% of group II and 55% of group III patients. Patients with both inferior and RV involvement had a significantly higher positive LP results independent from left ventricular ejection fraction. CONCLUSION: Therefore, increased risk of arrhythmia in those patients with both inferior MI localization and RV involvement should be taken into consideration.
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    Öğe
    The value of late potential anaysis as a reperfusion criterion in acute myocardial infarction
    (2000) Iltümür K.; Kaymak H.; Ülgen M.S.; Temamoğullari A.V.; Karabulut A.; Karadede A.; Alan S.
    Various methods are available to evaluate reperfusion following thrombolytic treatment (TT) in Acute Myocardial Infarction (AMI). A few authors reported an inverse correlation between late potential (LP) positiveness and reperfusion in signal averaged ECG studies. Current prospective study was planned to investigate the value of LP analysis as a criterion of reperfusion following TT in AMI. METHODS:Ninety-two AMI patients (76 males and 16 females, with an average age of ± years) who were admitted to our clinics in the first twelve hours of pain initiation and were exposed AMI first time were enrolled. All patients had TT (TPA, n=31 or Streptokinase, n=61). Their clinical and labaratory parameters were recorded. RESULTS:Infarct related vessel was demonstrated angiographically in 69 patients (75%). Twenty-three (25%) had an occluded infarct related vessel. The LP incidence was quite low in cases with a patent infarct related vessel (7%) whereas it was higher in those with an occluded vessel (80%)(p<0.0001).Sensivity, specificity, positive and negative predictive values of LP analysis to put forward infarct related vessel patency were 95%, 80%, 92% and 87%, respectively. CONCLUSION: LP analysis with signal-averaged ECG might be used as a reperfusion criterion in AMI cases following TT.