4 research outputs found
Anatomical axes of the proximal and distal halves of the femur in a normally aligned healthy population: implications for surgery
ST-Segment Elevation in the Right Precordial Leads in Patients with Acute Anterior Myocardial Infarction
Background: Elevation of ST segment in leads V3R/V4R, which is commonly encountered in right ventricular myocardial infarction, may also occur in patients with anterior ST elevation myocardial infarction (STEMI). However, the clinical impact of this finding in the setting of anterior myocardial infarction is not well understood.
Aims: We aimed to investigate the prognostic value of ST segment elevation in leads V3R/V4R in patients with first acute anterior myocardial infarction.
Study Design: Prospective cohort study.
Methods: Right precordial leads V3R/V4R were recorded in 111 patients admitted with first time anterior myocardial infarction. Patients were allocated into two groups based on the presence or absence of ST elevation in leads V3R/V4R. Demographic, biochemical and echocardiographic data, as well as the angiographic information, were recorded. In-hospital and 3 month mortality, and major adverse cardiac events (MACE), death, heart failure and ventricular dysrhythmia were also compared.
Results: ST elevation in lead V3R or V4R was present in 72 out of 111 patients (64.9%). Involvement of the proximal part of the left anterior descending (LAD) artery was not different in the two groups (44.4% of patients with elevation vs. 53.8% of patients without elevation, p=0.22). Post-myocardial infarction complications, mortality and major adverse cardiac events were similar in the two groups. Left ventricular ejection fraction (LVEF) was significantly lower in patients with ST elevation in V3R/V4R (35 %±8 vs. 38 %±8, p=0.02). Twenty three out of 111 patients (20.7%) developed heart failure, which was similar in the two groups [16 (22.2%) of patients with ST elevation vs. 7 (17.9%) of patients without ST elevation, p=0.39].
Conclusion: Although ST elevation in V3R/V4R can be present in patients with left anterior descending artery occlusion, it does not seem to predict the prognosis. Lower left ventricular ejection fraction in this group may play a role in the long-term prognosis; however, this issue needs further investigation
Recommended from our members
Anatomical axes of the proximal and distal halves of the femur in a normally aligned healthy population: implications for surgery
Background: The anatomical axis of the femur is crucial for determining the correct alignment in corrective osteotomies of the knee, total knee arthroplasty (TKA), and retrograde and antegrade femoral intramedullary nailing (IMN). The aim of this study was to propose the concept of different anatomical axes for the proximal and distal parts of the femur; compare these axes in normally aligned subjects and also to propose the clinical application of these axes. Methods: In this cross-sectional study, the horizontal distances between the anatomical axis of the proximal and distal halves of the femur and the center of the intercondylar notch were measured in 100 normally aligned femurs using standard full length alignment view X-rays. Results: The average age was 34.44 ± 11.14 years. The average distance from the proximal anatomical axis to the center of the intercondylar notch was 6.68 ± 5.23 mm. The proximal anatomical axis of femur passed lateral to the center of the intercondylar notch in 12 cases (12%), medial in 84 cases (84%) and exactly central in 4 cases (4%). The average distance from the distal anatomical axis to the center of the intercondylar notch was 3.63 ± 2.09 mm. The distal anatomical axis of the femur passed medially to the center of the intercondylar notch in 82 cases (82%) and exactly central in 18 cases (18%). There was a significant difference between the anatomical axis of the proximal and distal parts of the femur in reference to the center of intercondylar notch (P value < 0.05), supporting the hypothesis that anatomical axes of the proximal and distal halves of the femur are different in the coronal plane. Conclusions: While surgeons are aware that the anatomical axis of the distal part of the femur is different than the anatomical axis of the proximal part in patients with femoral deformities, we have shown that these axes are also different in the normally aligned healthy people due to the anatomy of the femur in coronal plane. Also the normal ranges provided here can be used as a reference for the alignment guide entry point in TKA and antegrade and retrograde intramedullary femoral nailing