Research Article
ST segment yükselmesi olan veya olmayan hastalarda D II derivasyonunda R / S oranının epidemiyolojik ve prognostik önemi
Abstract
Amaç: Akut koroner sendrom(ACS)’lu
hastaların elektrokardiyografisinde(ECG) DII derivasyonunda R’ın S’e
oranının(RSR), myokard infarktüsü(MI) sonrası oluşan komplikasyonlar, üç damar
koroner arter hastalığı(TVCAD) ve mortalite açısından etkilerinin
değerlendirilmesi amaçlanmıştır.
Yöntem: Bu retrospektif kesitsel
kohort çalışmasına, Ocak 2014-Aralık 2017 tarihleri arasında hastanemiz acil
servisine(ED) göğüs ağrısı nedeniyle başvuran ve kardiyoloji kliniğine
yatırılan ACS’lu 1102 hastanın verileri dahil edildi. Hastalar RSR değerinin
1’den küçük olmasına grup 1, RSR değerinin 1’den büyük olmasına grup 2 denildi.
Bu gruplar yaş, cinsiyet, tıkalı majör koroner damar(BMCA), Gensini Skoru (GS),
MI sonrası oluşan komplikasyonlar, kardiyak troponin I (cTnI), TVCAD ve mortalite
oranları açısından karşılaştırıldı.
Bulgular: Her iki cinste de ST
elevasyonlu MI(STEMI), unstabil angına(UA) ve non-ST elevasyonlu MI(NSTEMI)
grup 1’de daha sıktı. Ayrıca iskemik kalp yetmezliği(IHF), ventriküler
taşikardi(VT), akut akciğer ödemi(APE), kardiyak effüzyon(CE) ve tamponat(CT)
yine grup 1’de ön plandaydı. Oysa atriyoventriküler(AV) blok, TVCAD ve mortalite grup 2’de daha sıktı. Erkeklerde
STEMI, UA, NSTEMI, dal bloğu(BB), komplikasyonlar, TVCAD, BMCA ve mortalite
fazla bulundu. Atrial fibfilasyon (AF)
NSTEMI’da sıkken, BB akut inferior MI’da (AIMI) fazlaydı. IHF, VT, APE akut
anterior MI(AAMI) sık tespit edildi. AV blok ise AIMI daha fazlaydı. TVCAD ve
mortalite AAMI’da daha sıktı. BMCA AIMI’da sağ koroner arter(RCA) iken, AAMI’da
circumflex arter(Cx=L1) ve left anterior descending(LAD=L2)’i en sık tıkanan
damarlardı. UA ve NSTEMI’da en sık L2 tıkandığı tespit edildi.
Sonuç: ACS’da RSR düzeyleri
MI sonrası gelişen komplikasyonlar, TVCAD ve mortalite açısından prediktif
yardımcı bir değer olabilir.
References
- REFERENCES
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TIMI risk score for ST-elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment at presentation: An intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation 2000;102:2031-77. Melgarejo-Moreno A, Galcerá-Tomás J, Garciá-Alberola A, et al. Incidence, clinical characteristics, and prognostic significance of right bundle-branch block in acute myocardial infarction: a study in the thrombolytic era. Circulation 1997;96:1139-44.8. Ozdemir K, Uluca Y, Daniş G, et al. Importance of left anterior hemiblock development in inferior wall acute myocardial infarction. Angiology 2001;52:743-7.9.Tan H. Determination of ventricular hypertrophy and chronic cardiomyofibrosis in atrops by means of orthogonal system electrocardiography and vecto-cardiography. Associate Professor Thesis. İstanbul 1981.10.Yılmaz B. Physiology. Feryal Publishing, Ankara, 2000;212-21311. Kittleson MD Small Animal Cardiovascular Medicine .1998.12. Tilley LP, Smith FWK, Oyama MA, Sleeper MM. Manual of Canine and Feline Cardiology. Elsevier Inc, Canada, 2008;49-5013. Kavsak PA, MacRae AR, Lustig V, et al. The impact of the ESC/ACC redefinition of myocardial infarction and new sensitive troponin assays on the frequency of acute myocardial infarction. Am Heart J 2006;152:118-25.14. Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction-summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol 2002;40:1366-74.15. Bassand JP, Hamm CW, Ardissino D, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Task Force for Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of European Society of Cardiology. Eur Heart J 2007;28:1598-660.16. Panteghini M, Pagani F, Yeo KT, et al. Evaluation of imprecision for cardiac troponin assays at low-range concentrations. Clin Chem 2004;50:327-32.17.Cannon CP, Braunwald E: Unstable angina. In Braunwald Heart Disease 6 th ed. Philadelphia W. B. Saunders Company 2001:1232-71.18.AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes. Cırculation 2014;130:344-42619.Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983;51:606.20. Rosenbaum MB, Elizari MV, Lazzari JO. The hemiblocks. Oldsmar, FL: Tampa Tracings; 1970.21. Castellanos A, -Myerburg RJ. The Hemiblocks in Myocardial Infarction. New York: Appleton-Century-Crofts;1976.22. Kittleson MD Small Animal Cardiovascular Medicine .1998.23 Martin M. Small Animal ECGs: An Introductory Guide, Wiley- Blackwell, 2nd ed.200724. Fine DM. How to determine and interpret the mean electrical axis. Veterinary medicine, 2006;101(1): 28-3625. Waldo SW, Brenner DA, Li S, et al. Reperfusion times and in-hospital outcomes among patients with an isolated posterior myocardial infarction: Insights from the National Cardiovascular Data Registry(NCDR). Am Heart J 2014;167:350-4.26 102. Hamm CW, Ravkilde J, Gerhardt W, et al. The prognostic value of serum troponin T in unstable angina. N Engl J Med. 1992;327:146-50. 27. Hamm CW, Braunwald E. A classification of unstable angina revisited. Circulation. 2000;102:118-22. 28. Kaul P, Newby LK, Fu Y, et al. Troponin T and quantitative ST-segment depression offer complementary prognostic information in the risk stratification of acute coronary syndrome patients. J Am Coll Cardiol. 2003;41:371-80.29. Chen Y, Serfass RC, Mackey-Bojack SM, et al. Cardiac troponin T alterations in myocardium and serum of rats after stressful, prolonged intense exercise. J Appl Physiol. 2000;88:1749-55. 30. Antman EM, Tanasiyevic MJ, Thompson B, et al. Cardiac-spesific troponinI levels to predict the risk of mortality in patients with acute coronary syndrome. N Engl J Med 1996; 335: 1342-9 31. Ohman EM, Amstrong PW, Christenson RH, et al. Cardiac troponin T levels for riskstratifikasyon in acute myocardial iskemia. GUSTO IIA investigators. N Engl J Med 1966;31;335: 1333-4132. Morrow DA, Cannon CP, Rifai N, et. al. Ability of minor elevations of troponin I and T to identify patients with unstable angina and non-ST elevation myocardial infarction who benefit from an early invasive strategy: Results from a prospective, randomized trial. JAMA. 2001;286:2405-12.
- 33.Marriott, H. J. L., and Hogan, P. (1970). Hemiblock in acute myocardial infarction. Chest, 58, 342-344.34.Scheinman, M., and Brenman, B. (1972). Clinical and anatomic implications of intraventricular conduction block in acute myocardial infarction. Circulation, 46, 753-760.35.Col, J. J., and Weinberg, S. L. (1972). The incidence and mortality of intraventricular conduction defects in acute myocardial infarction. American Journal of Cardiology, 29, 344-350.36. Massing GK., and James, T. N. (1971). Anatomical configuration of the His bundle and proximal bundle branches in the human heart. Circulation, 43-44, Suppl. 2, 64.37. Levy S, Gerard R, Castellanos A Jr., Gharhamani A, Sommer LS. Pure left anterior hemiblock: hemodynamic and arteriographic aspects in patients with coronary artery disease. Eur J Cardiol 1978;8:553–63.38. Assali A, Sclarovsky S, Herz I, Solodky A, Sulkes J, Strasberg B. Importance of left anterior hemiblock development in inferior Wall acute myocardial infarction. Am J Cardiol 1997;79:672– 4.39. Biagini E, Elhendy A, Schinkel AFL, Nelwan S, Rizzello V, van Domburg RT,et al. Prognostic Significance of Left Anterior Hemiblock in Patients With Suspected Coronary Artery Disease. Journal of the American College of Cardiology. 2005; 46(5):858-6340.Lenegre, J. (1964). Etiology and pathology of bilateral bundlebranch block in relation to complete heart block. Progress in Cardiovascular Diseases, 6, 409-444.41.Massing, G. K., and James, T. N. (1971). Anatomical configuration of the His bundle and proximal bundle branches in the human heart. Circulation, 43-44, Suppl. 2, 64.42.Sutton, R., and Davies, M. (1968). The conduction system in acute myocardial infarction complicated by heart block. Circulation, 38, 987-992.43.Scheinman, M., and Brenman, B.(I972). Clinical and anatomic implications of intraventricular conduction blocks in acute myocardial infarction. Circulation, 46, 753.44. Rizzon, P., Di Biase, M., and Baissus, C. (I974). The intraventricular conduction defects in acute myocardial infarction. British Heart Journal, 36, 660.45.Rosenbaum MB, Elizari MV, Lazzari JO. The hemiblocks. New concepts of intraventricular conduction based on human anatomical, physiological and clinical studies. Oldsmar, Florida: Tampa Tracings, 1970.46. Demoulin JC, Kulbertus HE. Histopathological examination of concept of left hemiblock. Br HeartJI 1972; 34: 807-14.47. Chimient M,Salerno JA, Tavazzi L. Tachycardia-dependent left posterior hemiblock. Br Heart J 1981; 46: 687-9048. Corne RA, Beamish RE, Rollwagen RL. Significance of left anterior hemiblock. Br Heart J 1978;40:552–7.49. Yano K, Peskoe SM, Rhoads GG, Moore JO, Kagan A. Left axis deviation and left anterior hemiblock among 8,000 Japanese-American men. Am J Cardiol 1975;35:809 –15.50. Ostrander LD Jr. Left axis deviation: prevalence, associated conditions and prognosis. An epidemiologic study. Ann Intern Med 1971;75:23–8.51. Levy S, Gerard R, Castellanos A, Gharhamani AR, Sommer LS. Transient left anterior hemiblock during angina pectoris: coronarographic aspects and clinical significance. Eur J Cardiol 1979;9:215–2552.Norris, R. M., and Croxson, M. S. (1970). Bundle-branch block in acute myocardial infarction. American Heart Journal, 79, 728-733.53.Roos, J. C., and Dunning, A. J. (1970). Right bundle-branch block and left axis deviation in acute myocardial infarction. British Heart Journal, 32, 847-851.54. Scanlon, P. J., Pryor, R., and Blount, S. G., Jr. (1970). Right bundle-branch block associated with left superior or inferior intraventricular block. Circulation, 42, 1135-1142.55. Castellanos, A., Maytin, O., Arcebal, A. G., and Lemberg, L. (I970). Significance of complete right bundle-branch block with right axis deviation in absence of right ventricular hypertrophy. British Heart_Journal, 32, 85.56. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am JCardiol 1983;51:606.57. Oishi Y, Wakatsuki T, Nishikado A, Oki T, Ito S. Circulating adhesion molecules and severity of coronary atherosclerosis. Coron Artery Dis 2000;11:77-81.58. Col, J. J., and Weinberg, S. L. (1972). The incidence and mortality of intraventricular conduction defects in acute myocardial infarction. American Journal of Cardiology, 2g, 344.59. Rizzon P, Rossi L, Baissus C, Demoulin JC, Di Biase M. Left posterior hemiblock in acute myocardial infarction. British HeartJournal, I975;37, 711-720.60Scanlon, P. J., Pryor, R., Blount, S. G. . Right bundle-branch block associated with left superior or inferior intraventricular block. Circulation, 1970;42, II35.61. Pryor, R., and Blount, S. G. The clinical significance of true left axis deviation. Left intraventricular blocks. American Heart Journal, 1966:72, 391.62. Voridis, E., Plessas, S., Mallios, K., and Cokkinos, D. (I973). Blocs complets droits et bifasciculaires au cours de la phase aigud de l'infarctus du myocarde. Archives des Maladies du Coeur et des Vaisseaux, 66, II93.
The epidemiological and prognostic significance of the R/S Ratio in DII derivation in patients with or without ST-segment elevation
Abstract
Objective: The aim of this
study was to evaluate the significance of R/S ratio (RSR) in the Lead II
derivation of electrocardiography (ECG) in acute coronary syndrome (ACS)
patients, in regards to the complications associated with myocardial infarction
(MI), three-vessel coronary artery disease (TVCAD), and mortality.
Method: This
cross-sectional retrospective cohort study included a total of 1102 patients
with ACS, who presented to our hospital's emergency department (ED) with chest
pain and were admitted to the cardiology inpatient service between January 2014
and December 2017. The patients with an RSR value less than 1 were assigned to
group I and the patients with RSR values greater than 1 were assigned to group
II. These groups were compared in terms of age and gender; the presence of
blocked major coronary arteries (BMCA), complications associated with MI, and
TVCAD; Gensini Scores (GS), the levels of cardiac troponin I (cTnI), and
mortality rates.
Results: ST-segment elevation myocardial infarction
(STEMI), unstable angina (UA), and non-ST segment elevation myocardial
infarction (NSTEMI) were more frequent in group I in both genders. Ischemic
heart failure (IHF), ventricular tachycardia (VT), acute pulmonary edema (APE),
cardiac effusion (CE), and tamponade (CT) predominated in group I. However,
atrioventricular (AV) block, TVCAD, and mortality was more frequent in group
II. In men, STEMI, UA, NSTEMI, branch block (BB), complications, TVCAD, BMCA,
and mortality were found to be high.
Atrial fibrillation (AF) occurred more commonly in NSTEMI and BBB were
more common in acute inferior MI (AIMI). IHF, VT, and APE were commonly seen in
acute anterior MI (AAMI). AV block was more frequent in AIMI. TVCAD was more
common and the mortality rate was higher in AAMI. The BMCA was identified to be
the right coronary artery (RCA) in AIMI. The most commonly blocked vessels were
the circumflex artery (Cx=L1) and the left anterior descending artery (LAD=L2)
in AAMI. The most commonly blocked vessel was L2 in both UA and NSTEMI.
Conclusions: The RSR value may
become an adjunctive predictor for estimating the complications associated with
MI, TVCAD, and mortality in ACS.
References
- REFERENCES
- 1. Elliot WJ. Cardiovascular risk factors.Which ones can and should be remedied? Postgrad med 1994;96:49-58.2. Libby P. Current concepts of the pathogenesis of the acute coronary syndromes. Circulation 2001;104:365-72.3. De Luca G, Suryapranata H, Ottervanger JP, Antman EM. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation 2004;109:1223-5.4. Antoniucci D, Valenti R, Migliorini A, et al. Relation of time to treatment and mortality in patients with acute myocardial infarction undergoing primary coronary angioplasty. Am J Cardiol 2002;89:1248-52.5.Libby P. Coronary artery injuty and the biology of atherosclerosis: inflammation, thrombosis, and stabilization. Am J Cardiol. 2000; 86:3-96. Morrow DA, Antman EM, Charlesworth A, et al. TIMI risk score for ST-elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment at presentation: An intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation 2000;102:2031-77. Melgarejo-Moreno A, Galcerá-Tomás J, Garciá-Alberola A, et al. Incidence, clinical characteristics, and prognostic significance of right bundle-branch block in acute myocardial infarction: a study in the thrombolytic era. Circulation 1997;96:1139-44.8. Ozdemir K, Uluca Y, Daniş G, et al. Importance of left anterior hemiblock development in inferior wall acute myocardial infarction. Angiology 2001;52:743-7.9.Tan H. Determination of ventricular hypertrophy and chronic cardiomyofibrosis in atrops by means of orthogonal system electrocardiography and vecto-cardiography. Associate Professor Thesis. İstanbul 1981.10.Yılmaz B. Physiology. Feryal Publishing, Ankara, 2000;212-21311. Kittleson MD Small Animal Cardiovascular Medicine .1998.12. Tilley LP, Smith FWK, Oyama MA, Sleeper MM. Manual of Canine and Feline Cardiology. Elsevier Inc, Canada, 2008;49-5013. Kavsak PA, MacRae AR, Lustig V, et al. The impact of the ESC/ACC redefinition of myocardial infarction and new sensitive troponin assays on the frequency of acute myocardial infarction. Am Heart J 2006;152:118-25.14. Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction-summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol 2002;40:1366-74.15. Bassand JP, Hamm CW, Ardissino D, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Task Force for Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of European Society of Cardiology. Eur Heart J 2007;28:1598-660.16. Panteghini M, Pagani F, Yeo KT, et al. Evaluation of imprecision for cardiac troponin assays at low-range concentrations. Clin Chem 2004;50:327-32.17.Cannon CP, Braunwald E: Unstable angina. In Braunwald Heart Disease 6 th ed. Philadelphia W. B. Saunders Company 2001:1232-71.18.AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes. Cırculation 2014;130:344-42619.Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983;51:606.20. Rosenbaum MB, Elizari MV, Lazzari JO. The hemiblocks. Oldsmar, FL: Tampa Tracings; 1970.21. Castellanos A, -Myerburg RJ. The Hemiblocks in Myocardial Infarction. New York: Appleton-Century-Crofts;1976.22. Kittleson MD Small Animal Cardiovascular Medicine .1998.23 Martin M. Small Animal ECGs: An Introductory Guide, Wiley- Blackwell, 2nd ed.200724. Fine DM. How to determine and interpret the mean electrical axis. Veterinary medicine, 2006;101(1): 28-3625. Waldo SW, Brenner DA, Li S, et al. Reperfusion times and in-hospital outcomes among patients with an isolated posterior myocardial infarction: Insights from the National Cardiovascular Data Registry(NCDR). Am Heart J 2014;167:350-4.26 102. Hamm CW, Ravkilde J, Gerhardt W, et al. The prognostic value of serum troponin T in unstable angina. N Engl J Med. 1992;327:146-50. 27. Hamm CW, Braunwald E. A classification of unstable angina revisited. Circulation. 2000;102:118-22. 28. Kaul P, Newby LK, Fu Y, et al. Troponin T and quantitative ST-segment depression offer complementary prognostic information in the risk stratification of acute coronary syndrome patients. J Am Coll Cardiol. 2003;41:371-80.29. Chen Y, Serfass RC, Mackey-Bojack SM, et al. Cardiac troponin T alterations in myocardium and serum of rats after stressful, prolonged intense exercise. J Appl Physiol. 2000;88:1749-55. 30. Antman EM, Tanasiyevic MJ, Thompson B, et al. Cardiac-spesific troponinI levels to predict the risk of mortality in patients with acute coronary syndrome. N Engl J Med 1996; 335: 1342-9 31. Ohman EM, Amstrong PW, Christenson RH, et al. Cardiac troponin T levels for riskstratifikasyon in acute myocardial iskemia. GUSTO IIA investigators. N Engl J Med 1966;31;335: 1333-4132. Morrow DA, Cannon CP, Rifai N, et. al. Ability of minor elevations of troponin I and T to identify patients with unstable angina and non-ST elevation myocardial infarction who benefit from an early invasive strategy: Results from a prospective, randomized trial. JAMA. 2001;286:2405-12.
- 33.Marriott, H. J. L., and Hogan, P. (1970). Hemiblock in acute myocardial infarction. Chest, 58, 342-344.34.Scheinman, M., and Brenman, B. (1972). Clinical and anatomic implications of intraventricular conduction block in acute myocardial infarction. Circulation, 46, 753-760.35.Col, J. J., and Weinberg, S. L. (1972). The incidence and mortality of intraventricular conduction defects in acute myocardial infarction. American Journal of Cardiology, 29, 344-350.36. Massing GK., and James, T. N. (1971). Anatomical configuration of the His bundle and proximal bundle branches in the human heart. Circulation, 43-44, Suppl. 2, 64.37. Levy S, Gerard R, Castellanos A Jr., Gharhamani A, Sommer LS. Pure left anterior hemiblock: hemodynamic and arteriographic aspects in patients with coronary artery disease. Eur J Cardiol 1978;8:553–63.38. Assali A, Sclarovsky S, Herz I, Solodky A, Sulkes J, Strasberg B. Importance of left anterior hemiblock development in inferior Wall acute myocardial infarction. Am J Cardiol 1997;79:672– 4.39. Biagini E, Elhendy A, Schinkel AFL, Nelwan S, Rizzello V, van Domburg RT,et al. Prognostic Significance of Left Anterior Hemiblock in Patients With Suspected Coronary Artery Disease. Journal of the American College of Cardiology. 2005; 46(5):858-6340.Lenegre, J. (1964). Etiology and pathology of bilateral bundlebranch block in relation to complete heart block. Progress in Cardiovascular Diseases, 6, 409-444.41.Massing, G. K., and James, T. N. (1971). Anatomical configuration of the His bundle and proximal bundle branches in the human heart. Circulation, 43-44, Suppl. 2, 64.42.Sutton, R., and Davies, M. (1968). The conduction system in acute myocardial infarction complicated by heart block. Circulation, 38, 987-992.43.Scheinman, M., and Brenman, B.(I972). Clinical and anatomic implications of intraventricular conduction blocks in acute myocardial infarction. Circulation, 46, 753.44. Rizzon, P., Di Biase, M., and Baissus, C. (I974). The intraventricular conduction defects in acute myocardial infarction. British Heart Journal, 36, 660.45.Rosenbaum MB, Elizari MV, Lazzari JO. The hemiblocks. New concepts of intraventricular conduction based on human anatomical, physiological and clinical studies. Oldsmar, Florida: Tampa Tracings, 1970.46. Demoulin JC, Kulbertus HE. Histopathological examination of concept of left hemiblock. Br HeartJI 1972; 34: 807-14.47. Chimient M,Salerno JA, Tavazzi L. Tachycardia-dependent left posterior hemiblock. Br Heart J 1981; 46: 687-9048. Corne RA, Beamish RE, Rollwagen RL. Significance of left anterior hemiblock. Br Heart J 1978;40:552–7.49. Yano K, Peskoe SM, Rhoads GG, Moore JO, Kagan A. Left axis deviation and left anterior hemiblock among 8,000 Japanese-American men. Am J Cardiol 1975;35:809 –15.50. Ostrander LD Jr. Left axis deviation: prevalence, associated conditions and prognosis. An epidemiologic study. Ann Intern Med 1971;75:23–8.51. Levy S, Gerard R, Castellanos A, Gharhamani AR, Sommer LS. Transient left anterior hemiblock during angina pectoris: coronarographic aspects and clinical significance. Eur J Cardiol 1979;9:215–2552.Norris, R. M., and Croxson, M. S. (1970). Bundle-branch block in acute myocardial infarction. American Heart Journal, 79, 728-733.53.Roos, J. C., and Dunning, A. J. (1970). Right bundle-branch block and left axis deviation in acute myocardial infarction. British Heart Journal, 32, 847-851.54. Scanlon, P. J., Pryor, R., and Blount, S. G., Jr. (1970). Right bundle-branch block associated with left superior or inferior intraventricular block. Circulation, 42, 1135-1142.55. Castellanos, A., Maytin, O., Arcebal, A. G., and Lemberg, L. (I970). Significance of complete right bundle-branch block with right axis deviation in absence of right ventricular hypertrophy. British Heart_Journal, 32, 85.56. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am JCardiol 1983;51:606.57. Oishi Y, Wakatsuki T, Nishikado A, Oki T, Ito S. Circulating adhesion molecules and severity of coronary atherosclerosis. Coron Artery Dis 2000;11:77-81.58. Col, J. J., and Weinberg, S. L. (1972). The incidence and mortality of intraventricular conduction defects in acute myocardial infarction. American Journal of Cardiology, 2g, 344.59. Rizzon P, Rossi L, Baissus C, Demoulin JC, Di Biase M. Left posterior hemiblock in acute myocardial infarction. British HeartJournal, I975;37, 711-720.60Scanlon, P. J., Pryor, R., Blount, S. G. . Right bundle-branch block associated with left superior or inferior intraventricular block. Circulation, 1970;42, II35.61. Pryor, R., and Blount, S. G. The clinical significance of true left axis deviation. Left intraventricular blocks. American Heart Journal, 1966:72, 391.62. Voridis, E., Plessas, S., Mallios, K., and Cokkinos, D. (I973). Blocs complets droits et bifasciculaires au cours de la phase aigud de l'infarctus du myocarde. Archives des Maladies du Coeur et des Vaisseaux, 66, II93.
There are 3 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Surgical Science Research Articles |
| Authors | |
| Publication Date | March 28, 2019 |
| Acceptance Date | March 12, 2019 |
| Published in Issue | Year 2019Volume: 41 Issue: 1 |