Planarity of the spatial QRS loop of vectorcardiogram is a crucial diagnostic and prognostic parameter in acute myocardial infarction. 2019

Sayantani Choudhuri, and Tania Ghosal, and Damodar Prasad Goswami, and Arnab Sengupta
Dept. of Physiology, Calcutta Medical College, 88, College Street, Calcutta 700073, India.

Vectorcardiogram (VCG) is a recurring, near-periodic pattern of cardiac dynamics that graphically represents the trajectory of the tip of cardiac vectors in three dimensional space with varying time. VCG is constructed by drawing the instantaneous vectors from a zero reference point according to direction, magnitude and polarity in the space. It is more informative and sensitive than conventional ECG as an evaluation tool of the physiology of cardiac dynamics. Each heart cycle consists of three loops corresponding to P, QRS, and T wave activities in VCG. The morphological assessment of the QRS loop was carried out in order to analyze the spatial vectors of the ventricles and their patho-physiological correlation in various cardiac diseases. It was found that, the three dimensional QRS loop in healthy individuals lies in a plane. It is rather surprising that the normal spatial QRS loop lies in a single plane, considering the complex structure of the ventricular musculature together with the numerous possible pathways along which the depolarization impulse passes. The highly curious phenomenon of planarity of the spatial QRS loop was explained by uniform double layer (UDL) theory, which postulates the phenomenon of activation wave-fronts that propagate with a constant & uniform rate throughout the myocardium. Acute myocardial infarction results in loss of structural and functional integrity of the different layers of heart, perturbation of the uniformity in wave propagation due to the disturbance in directional symmetry, development of nonlinear relationships among the concerned variables, loss of homogeneity and complete loss of planarity of the 3D-QRS loop. The planarity of the 3D-QRS loop is a highly restricted and sensitive parameter and a characteristic feature of normal heart and can be utilized as a test for diagnostic screening of cardiac normalcy and the loss of planarity may be a conspicuous feature of AMI. It will be reasonable to study the morphology of the spatial QRS loop in patients of AMI throughout the course of disease and also in a regular interval through the long-term follow up period. It is expected that with the reperfusion, recovery and salvage of the diseased myocardium; the homogeneity and the intensity of the line density of the membrane current of the UDL would gradually recover with retrieval of the planarity of the spatial QRS loop. The temporal pattern of characteristics alteration of the QRS loop planarity with the natural course of the disease requires intensive evaluation. We propose that, the planarity of the spatial QRS loop, its loss, involution and reversal is a temporal series of events in AMI and also a crucial diagnostic and prognostic parameter.

UI MeSH Term Description Entries
D009203 Myocardial Infarction NECROSIS of the MYOCARDIUM caused by an obstruction of the blood supply to the heart (CORONARY CIRCULATION). Cardiovascular Stroke,Heart Attack,Myocardial Infarct,Cardiovascular Strokes,Heart Attacks,Infarct, Myocardial,Infarction, Myocardial,Infarctions, Myocardial,Infarcts, Myocardial,Myocardial Infarctions,Myocardial Infarcts,Stroke, Cardiovascular,Strokes, Cardiovascular
D009206 Myocardium The muscle tissue of the HEART. It is composed of striated, involuntary muscle cells (MYOCYTES, CARDIAC) connected to form the contractile pump to generate blood flow. Muscle, Cardiac,Muscle, Heart,Cardiac Muscle,Myocardia,Cardiac Muscles,Heart Muscle,Heart Muscles,Muscles, Cardiac,Muscles, Heart
D011379 Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D003936 Diagnosis, Computer-Assisted Application of computer programs designed to assist the physician in solving a diagnostic problem. Computer-Assisted Diagnosis,Computer Assisted Diagnosis,Computer-Assisted Diagnoses,Diagnoses, Computer-Assisted,Diagnosis, Computer Assisted
D004562 Electrocardiography Recording of the moment-to-moment electromotive forces of the HEART as projected onto various sites on the body's surface, delineated as a scalar function of time. The recording is monitored by a tracing on slow moving chart paper or by observing it on a cardioscope, which is a CATHODE RAY TUBE DISPLAY. 12-Lead ECG,12-Lead EKG,12-Lead Electrocardiography,Cardiography,ECG,EKG,Electrocardiogram,Electrocardiograph,12 Lead ECG,12 Lead EKG,12 Lead Electrocardiography,12-Lead ECGs,12-Lead EKGs,12-Lead Electrocardiographies,Cardiographies,ECG, 12-Lead,EKG, 12-Lead,Electrocardiograms,Electrocardiographies, 12-Lead,Electrocardiographs,Electrocardiography, 12-Lead
D006321 Heart The hollow, muscular organ that maintains the circulation of the blood. Hearts
D006352 Heart Ventricles The lower right and left chambers of the heart. The right ventricle pumps venous BLOOD into the LUNGS and the left ventricle pumps oxygenated blood into the systemic arterial circulation. Cardiac Ventricle,Cardiac Ventricles,Heart Ventricle,Left Ventricle,Right Ventricle,Left Ventricles,Right Ventricles,Ventricle, Cardiac,Ventricle, Heart,Ventricle, Left,Ventricle, Right,Ventricles, Cardiac,Ventricles, Heart,Ventricles, Left,Ventricles, Right
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001145 Arrhythmias, Cardiac Any disturbances of the normal rhythmic beating of the heart or MYOCARDIAL CONTRACTION. Cardiac arrhythmias can be classified by the abnormalities in HEART RATE, disorders of electrical impulse generation, or impulse conduction. Arrhythmia,Arrythmia,Cardiac Arrhythmia,Cardiac Arrhythmias,Cardiac Dysrhythmia,Arrhythmia, Cardiac,Dysrhythmia, Cardiac
D012815 Signal Processing, Computer-Assisted Computer-assisted processing of electric, ultrasonic, or electronic signals to interpret function and activity. Digital Signal Processing,Signal Interpretation, Computer-Assisted,Signal Processing, Digital,Computer-Assisted Signal Interpretation,Computer-Assisted Signal Interpretations,Computer-Assisted Signal Processing,Interpretation, Computer-Assisted Signal,Interpretations, Computer-Assisted Signal,Signal Interpretation, Computer Assisted,Signal Interpretations, Computer-Assisted,Signal Processing, Computer Assisted

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