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<title>Ischemic-appearing electrocardiographic changes predict myocardial injury in patients with intracerebral hemorrhage - The American Journal of Emergency Medicine</title>
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                        </a></div><h1 class="articleTitle"><h1 class="articleTitle">Ischemic-appearing electrocardiographic changes predict myocardial injury in patients with intracerebral hemorrhage<a href="#article-footnote-☆" id="back-article-footnote-☆">☆</a><a href="#article-footnote-☆☆" id="back-article-footnote-☆☆">☆☆</a><a href="#article-footnote-★" id="back-article-footnote-★">★</a></h1></h1><div class="authorGroup"><div class="author"> <a class="openAuthorLayer layerTrigger" id="openAuthor_" href="javascript:void(0);">Kohei Hasegawa</a><div class="authorLayer hoverLayer notCollab" role="alertdialog" aria-describedby="_compliance" tabindex="-1" data-target=""><span class="closeBtn" role="button" tabindex="0" aria-label="close window">x</span><div class="header" id="_compliance">Kohei Hasegawa</div><div><a href="/">Search for articles by this author</a><h4>Affiliations</h4><ul class="affiliations"><li>Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA</li></ul></div></div>, MD</div>,<div class="author"> <a class="openAuthorLayer layerTrigger" id="openAuthor_" href="javascript:void(0);">Megan L. Fix</a><div class="authorLayer hoverLayer notCollab" role="alertdialog" aria-describedby="_compliance" tabindex="-1" data-target=""><span class="closeBtn" role="button" tabindex="0" aria-label="close window">x</span><div class="header" id="_compliance">Megan L. Fix</div><div><a href="/">Search for articles by this author</a><h4>Affiliations</h4><ul class="affiliations"><li>Department of Emergency Medicine, the University of Utah Hospital, Salt Lake City, UT, USA</li></ul></div></div>, MD</div>,<div class="author"> <a class="openAuthorLayer layerTrigger" id="openAuthor_" href="javascript:void(0);">Lauren Wendell</a><div class="authorLayer hoverLayer notCollab" role="alertdialog" aria-describedby="_compliance" tabindex="-1" data-target=""><span class="closeBtn" role="button" tabindex="0" aria-label="close window">x</span><div class="header" id="_compliance">Lauren Wendell</div><div><a href="/">Search for articles by this author</a><h4>Affiliations</h4><ul class="affiliations"><li>Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA</li></ul></div></div>, BS</div>,<div class="author"> <a class="openAuthorLayer layerTrigger" id="openAuthor_" href="javascript:void(0);">Kristin Schwab</a><div class="authorLayer hoverLayer notCollab" role="alertdialog" aria-describedby="_compliance" tabindex="-1" data-target=""><span class="closeBtn" role="button" tabindex="0" aria-label="close window">x</span><div class="header" id="_compliance">Kristin Schwab</div><div><a href="/">Search for articles by this author</a><h4>Affiliations</h4><ul class="affiliations"><li>Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA</li></ul></div></div>, BS</div>,<div class="author"> <a class="openAuthorLayer layerTrigger" id="openAuthor_" href="javascript:void(0);">Hakan Ay</a><div class="authorLayer hoverLayer notCollab" role="alertdialog" aria-describedby="_compliance" tabindex="-1" data-target=""><span class="closeBtn" role="button" tabindex="0" aria-label="close window">x</span><div class="header" id="_compliance">Hakan Ay</div><div><a href="/">Search for articles by this author</a><h4>Affiliations</h4><ul class="affiliations"><li>Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA</li></ul></div></div>, MD</div>,<div class="author"> <a class="openAuthorLayer layerTrigger" id="openAuthor_" href="javascript:void(0);">Eric E. Smith</a><div class="authorLayer hoverLayer notCollab" role="alertdialog" aria-describedby="_compliance" tabindex="-1" data-target=""><span class="closeBtn" role="button" tabindex="0" aria-label="close window">x</span><div class="header" id="_compliance">Eric E. Smith</div><div><a href="/">Search for articles by this author</a><h4>Affiliations</h4><ul class="affiliations"><li>The Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada</li></ul></div></div>, MD, MPH</div>,<div class="author"> <a class="openAuthorLayer layerTrigger" id="openAuthor_" href="javascript:void(0);">Steven M. Greenberg</a><div class="authorLayer hoverLayer notCollab" role="alertdialog" aria-describedby="_compliance" tabindex="-1" data-target=""><span class="closeBtn" role="button" tabindex="0" aria-label="close window">x</span><div class="header" id="_compliance">Steven M. Greenberg</div><div><a href="/">Search for articles by this author</a><h4>Affiliations</h4><ul class="affiliations"><li>Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA</li></ul></div></div>, MD, PhD</div>,<div class="author"> <a class="openAuthorLayer layerTrigger" id="openAuthor_" href="javascript:void(0);">Jonathan Rosand</a><div class="authorLayer hoverLayer notCollab" role="alertdialog" aria-describedby="_compliance" tabindex="-1" data-target=""><span class="closeBtn" role="button" tabindex="0" aria-label="close window">x</span><div class="header" id="_compliance">Jonathan Rosand</div><div><a href="/">Search for articles by this author</a><h4>Affiliations</h4><ul class="affiliations"><li>Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA</li></ul><ul class="affiliations"><li>The Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA</li></ul></div></div>, MD, MS</div>,<div class="author"> <a class="openAuthorLayer layerTrigger" id="openAuthor_" href="javascript:void(0);">Joshua N. Goldstein</a><div class="authorLayer hoverLayer notCollab" role="alertdialog" aria-describedby="_compliance" tabindex="-1" data-target=""><span class="closeBtn" role="button" tabindex="0" aria-label="close window">x</span><div class="header" id="_compliance">Joshua N. Goldstein</div><div><a href="/">Search for articles by this author</a><h4>Affiliations</h4><ul class="affiliations"><li>Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA</li></ul></div></div>, MD, PhD</div>,<div class="author"> <a class="openAuthorLayer layerTrigger" id="openAuthor_" href="javascript:void(0);">David F.M. Brown</a><div class="authorLayer hoverLayer notCollab" role="alertdialog" aria-describedby="_compliance" tabindex="-1" data-target=""><span class="closeBtn" role="button" tabindex="0" aria-label="close window">x</span><div class="header" id="_compliance">David F.M. Brown</div><div><a href="/">Search for articles by this author</a><h4>Affiliations</h4><ul class="affiliations"><li>Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA</li></ul><h4>Correspondence</h4><ul class="correspondence"><li>Corresponding author. Tel.: +1 617 7265273; fax: +1 617 7260311.</li></ul></div></div>, MD<a class="openAuthorLayer layerTrigger" id="openAuthor_" href="javascript:void(0);"><img src="../../templates/jsp/_style2/_marlin/images/article_notepad.gif" alt="correspondence"></img></a><div class="authorLayer hoverLayer notCollab" role="alertdialog" aria-describedby="_compliance" tabindex="-1" data-target=""><span class="closeBtn" role="button" tabindex="0" aria-label="close window">x</span><div class="header" id="_compliance">David F.M. Brown</div><div><a href="/">Search for articles by this author</a><h4>Affiliations</h4><ul class="affiliations"><li>Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA</li></ul><h4>Correspondence</h4><ul class="correspondence"><li>Corresponding author. Tel.: +1 617 7265273; fax: +1 617 7260311.</li></ul></div></div><a class="email" href="mailto:dbrown2@partners.org" title="Email the author"><img src="../../templates/jsp/_style2/_marlin/images/icon_email.png" alt="email"></img></a></div></div><div class="oaAltContainer"><span class="altmetric-embed" data-doi="10.1016/j.ajem.2011.02.007" data-link-target="_blank"></span></div><div class="doi">DOI:
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                    </div><section class="widget widget-regular abstractImages"><header class="widget-header header-regular">Figures</header><div class="widget-body body body-regular"><div class="image"><div><img src="../../cms/attachment/2004397284/2018599541/gr1.sml.jpg"></img></div><div class="caption"><p class="caption-title"><span class="label">Fig. 1</span></p><p>A, Head computed tomographic scan of patient OF on admission. An illustrative patient, OF is a 70-year-old woman with no history of coronary artery disease who presented with confusion. Her head computed tomographic scan showed right temporoparietal ICH. Her ECG showed T wave inversions in leads I, aVL, and V<sub>1</sub> to V<sub>6</sub>. Her peak troponin was 1.8 ng/mL. The patient subsequently underwent a stress test performed with technetium Tc 99m sestamibi that disclosed a modest degree of reversible inferoapical defect. B, Electrocardiogram of patient OF on admission.</p></div></div></div></section><div class="abstract"><h2 class="sectionTitle">Abstract</h2><h3 class="sectionTitle">Objectives</h3><p>Myocardial injury is common among patients with intracerebral hemorrhage (ICH). However, it is challenging for emergency physicians to recognize acute myocardial injury in this population, as electrocardiographic (ECG) abnormalities are common in this setting. Our objective is to examine whether ischemic-appearing ECG changes predict subsequent myocardial injury in the context of ICH.</p><h3 class="sectionTitle">Methods</h3><p>Consecutive patients with primary ICH presenting to a single academic center were prospectively enrolled. Electrocardiograms were retrospectively reviewed by 3 independent readers. <em>Anatomical areas of ischemia</em> were defined as I and aVL; II, III, and aVF; V<sub>1</sub> to V<sub>4</sub>; and V<sub>5</sub> and V<sub>6</sub>. Medical record review identified myocardial injury, defined as troponin I or T elevation (cutoff 1.5 and 0.1 ng/mL, respectively), within 30 days.</p><h3 class="sectionTitle">Results</h3><p>Between 1998 and 2004, 218 patients presented directly to our emergency department and did not have a do-not-resuscitate/do-not-intubate order; arrival ECGs and troponin levels were available for 206 patients. Ischemic-appearing changes were noted in 41% of patients, and myocardial injury was noted in 12% of patients. Ischemic-appearing changes were more common in patients with subsequent injury (64% vs 37%; <em>P</em> = .02). After multivariable analysis controlling for age and cardiac risk factors, ischemic-appearing ECG changes independently predicted myocardial injury (odds ratio, 3.2; 95% confidence interval, 1.3-8.2). In an exploratory analysis, ischemic-appearing ECG changes in leads I and aVL as well as V<sub>5</sub> and V<sub>6</sub> were more specific for myocardial injury (<em>P</em> = .002 and <em>P</em> = .03, respectively).</p><h3 class="sectionTitle">Conclusion</h3><p>In conclusion, although a range of ECG abnormalities can occur after ICH, the finding of ischemic-appearing changes in an anatomical distribution can help predict which patients are having true myocardial injury.</p></div><div class="content"></div><div class="denialInfo">
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</div></div></div><div class="footnotes"><p><a href="#back-article-footnote-☆" id="article-footnote-☆">☆</a>Presentation information: Abstract presented at SAEM Annual Meeting, Chicago, IL, May 2007.</p><p><a href="#back-article-footnote-☆☆" id="article-footnote-☆☆">☆☆</a>Conflicts of Interest Disclosure: Dr Joshua N. Goldstein has received consulting fees from CSL Behring.</p><p><a href="#back-article-footnote-★" id="article-footnote-★">★</a>This study is funded by the National Institute of Neurological Disorders and Stroke ( NIH K23NS059774 ).</p></div><div class="copyright">© 2012 Elsevier Inc. Published by Elsevier Inc.  All rights reserved.</div><div class="enhancedViewContent"></div><input type="hidden" class="extraCssClass" value="doctopic-1- label-"></input>
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