Iranian Heart Journal

Iranian Heart Journal

Comparison of QT Dispersion Alterations and Left Ventricular Systolic Function in Acute ST-Elevation Myocardial Infarction Following Revascularization by Thrombolytic Therapy versus Primary PCI

Document Type : Original Article

Authors
Yasser Ahmed Abd El Hady 1
Hesham Boshra Mahmoud 1
Mina Michael Mories 2
Osama Ahmed Amin 1
1 Department of Cardiology, Faculty of Medicine, Beni-Suef University, Egypt.
2 Department of Cardiology, Sohag Health Insurance Hospital, Egypt.
Abstract
Background: Limited information exists regarding alterations in QT dispersion (QTd) in patients with acute ST-elevation myocardial infarction (STEMI) following thrombolytic therapy compared to primary percutaneous coronary intervention (PCI). Speckle-tracking echocardiography (STE) has emerged as a crucial prognostic tool in recent STEMI cases, allowing for the assessment of global and regional remodeling. We sought to analyze the changes in the QTd interval and global longitudinal strain (GLS) in STEMI patients after early reperfusion.
 
Methods: This study is a prospective observational analysis involving 100 STEMI patients. The participants were divided into 2 groups: Group I, consisting of 55 patients treated with primary PCI, and Group II, composed of 45 patients treated with thrombolytic therapy. A 12-lead surface ECG was performed upon admission and 48 hours post-revascularization to assess QTd changes in patients receiving thrombolytic therapy versus those undergoing primary PCI. GLS was evaluated using STE 72 hours after revascularization.
 
Results: No differences were observed between the 2 groups concerning baseline characteristics. A significant reduction in QTd occurred after revascularization in both groups, with a greater mean reduction noted in the primary PCI group. Patients in the primary PCI group exhibited significantly more negative GLS values than those in the thrombolytic group. Admission QTd and the percentage of QTd reduction were significant predictors of ventricular tachycardia.
 
Conclusions: This study underscores the potential of primary PCI to enhance patient outcomes in STEMI. The superior GLS results, reduced incidence of ventricular arrhythmias, and QTd reduction following revascularization in STEMI patients indicate that primary PCI could significantly transform patient care. (Iranian Heart Journal 2025; 26(3): 27-40)
Keywords
QT dispersion
Global longitudinal strain
Primary PCI
Acute ST-elevation myocardial infarction
Thrombolytic therapy
  1. Odemuyiwa O, Malik M, Farrell T, et al. Comparison of the predictive characteristics of heart rate variability index and left ventricular ejection fraction for all-cause mortality, arrhythmic events, and sudden death after acute myocardial infarction. Am J Cardiol. 1991; 68(5):434-439. doi:10.1016/0002-9149(91)90774-f
  2. Holmes DR Jr, Berger PB, Hochman JS, et al. Cardiogenic shock in patients with acute ischemic syndromes with and without ST-segment elevation. Circulation. 1999; 100(20):2067-2073. doi:10.1161/01.cir.100.20.2067
  3. Goldberg R, Goff D, Cooper L, et al. Age and sex differences in presentation of symptoms among patients with acute coronary disease: the REACT Trial. Rapid Early Action for Coronary Treatment. Coron Artery Dis. 2000; 11(5):399-407. doi:10.1097/00019501-200007000-00004
  4. Casolo GC, Stroder P, Signorini C, et al. Heart rate variability during the acute phase of myocardial infarction. Circulation. 1992; 85(6):2073-2079. doi:10.1161/01.cir.85.6.2073
  5. Appleby MA, Angeja BG, Dauterman K, et al. Angiographic assessment of myocardial perfusion: TIMI myocardial perfusion (TMP) grading system. Heart. 2001; 86(5):485-486. doi:10.1136/heart.86.5.485
  6. Cameli M, Mandoli GE, Sciaccaluga C, et al. More than ten years of speckle tracking echocardiography: Still a novel technique or a definite tool for clinical practice? Echocardiography. 2019; 36(5):958-970. doi:10.1111/echo.14339
  7. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for managing acute myocardial infarction in patients with ST-segment elevation. Eur Heart J. 2018; 39(2):119-177. doi:10.1093/eurheartj/ehx393
  8. Sahu P, Lim PO, Rana BS, et al. QT dispersion in medicine: electrophysiological holy grail or fool's gold? QJM. 2000; 93(7):425-431. doi:10.1093/qjmed/93.7.425
  9. Lacalzada J, de la Rosa A, Izquierdo MM, et al. Left ventricular global longitudinal systolic strain predicts adverse remodeling and subsequent cardiac events in patients with acute myocardial infarction treated with primary percutaneous coronary intervention. Int J Cardiovasc Imaging. 2015; 31(3):575-584. doi:10.1007/s10554-015-0593-2
  10. Neglia D, Rovai D, Caselli C, et al. Detection of significant coronary artery disease by noninvasive anatomical and functional imaging. Circ Cardiovasc Imaging. 2015;8(3). doi:10.1161/CIRCIMAGING.114.002179
  11. Oni Heris S, Rahimi B, Faridaalaee G, et al. QT dispersion after thrombolytic therapy. Int Cardiovasc Res J. 2014; 8(4):161-165.
  12. Hamza O, Mouffok M, Bouzid A, et al. CRT-108 evaluation of corrected QT and QT dispersion changes in acute ST-elevation myocardial infarction after primary percutaneous coronary intervention. JACC Cardiovasc Interv. 2014; 7(2):S9. doi:10.1016/j.jcin.2014.01.005
  13. Shahir K, George H, M F. Assessment of QT Dispersion in Patients with Acute STEMI Receiving Thrombolytic Versus Those Performing Primary Percutaneous Coronary Intervention (PCI) Therapy.
  14. P., J. H., S. C. Prognostic value of QT dispersion change following primary percutaneous coronary intervention in acute ST-elevation myocardial infarction.
  15. Valizadeh A, Soltanabadi S, Koushafar S, et al. Comparison of QT dispersion in patients with ST-elevation acute myocardial infarction (STEMI) before and after treatment by streptokinase versus primary percutaneous coronary intervention (PCI). BMC Cardiovasc Disord. 2020; 20(1):493. doi:10.1186/s12872-020-01767-9
  16. George SK, Waly HM, Abdul Moteleb MT. Assessment of QT dispersion in patients with acute STEMI receiving thrombolytic versus those performing primary percutaneous coronary intervention (PCI) therapy.
  17. Cavusoglu Y, Gorenek B, Timuralp B, et al. Comparison of QT dispersion between primary coronary angioplasty and thrombolytic therapy for acute myocardial infarction. Isr Med Assoc J. 2001; 3(5):333-337.
  18. Hassan T, Abou Omar M, Alaarag A. QT Dispersion Changes Following Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction Comparison between Primary PCI Plus Thrombectomy and Primary PCI without Thrombectomy. J Clin Exp Cardiol. 2018; 09. doi:10.4172/2155-9880.1000595
  19. Paul A, George PV. Left ventricular global longitudinal strain following revascularization in acute ST-elevation myocardial infarction - A comparison of primary angioplasty and Streptokinase-based pharmacoinvasive strategy. Indian Heart J. 2017;69(6):695-699. doi:10.1016/j.ihj.2017.04.010
  20. Mangoni AA, Kinirons MT, Swift CG, et al. The impact of age on QT interval and QT dispersion in healthy subjects is a regression analysis. Age Ageing. 2003; 32(3):326-331. doi:10.1093/ageing/32.3.326
Iranian Heart Journal
Volume 26, Issue 3
Summer 2025
Pages 27-40