Characteristics of Inferior Myocardial Infarction With a Special Electrocardiographic Pattern (Aslanger) in Metabolic Syndrome

Aim. To evaluate the features of ST-segment elevation myocardial infarction with the Aslanger pattern in comparison with traditional forms of inferior myocardial infarction in metabolic syndrome.

Material and methods. This study included 30 patients with inferior myocardial infarction in the presence of metabolic syndrome: 9 patients with the Aslanger electrocardiographic pattern (group 1, age 59.7 [58.4; 63.1] years) and the rest with one of the traditional forms (control group, 59.9 [57.2; 63.8] years, matched by all criteria of metabolic syndrome). All patients underwent primary percutaneous intervention with assessment of the angiographic picture. The magnitude of ST-segment elevation was measured in lead III at the J point and following 0.06 seconds, and the optimal threshold value of this indicator was determined for a new picture of myocardial infarction.

Results. The infarct-related artery in the Aslanger pattern was more often the circumflex artery (p=0.0099), and coronary thrombosis was characterized by a lower TIMI thrombus grade (p=0.014). SYNTAX values for the Aslanger pattern and for the traditional picture of inferior infarction with ST elevation in lead II≥III were higher than for a similar picture with ST elevation in lead III>II. The level of cTnI at admission (p=0.013) and after 24 hours (p=0.0017), the platelet count (p=0.0011) and mean volume (p=0.0047) in group 1 had smaller values than with traditional inferior infarction. The ST elevation at J point and at J+0.06 s point for lead III with the Aslanger pattern was significantly lower than values of such shift in lead III>II and lead II≥III with traditional inferior infarction (p<0.001). An elevation value ≤1.5 mm at J point +0.06 s was a predictor of infarction with the Aslanger pattern. Constructing the ROC curve made it possible to determine that with the Aslanger pattern, the best cutoff value for this index is 2 mm.

Conclusion. Myocardial infarction with the Aslanger pattern as compared with traditional lower infarction in metabolic syndrome is characterized by specific individual angiographic signs, lower ST segment elevation, cTnI level, and thrombotic disorders.

1. Aslanger E, Yıldırımtürk Ö, Şimşek B, Sungur A, Türer Cabbar A, Bozbeyoğlu E et al. A new electrocardiographic pattern indicating inferior myocardial infarction. Journal of Electrocardiology. 2020;61:41–6. DOI: 10.1016/j.jelectrocard.2020.04.008

2. Aslanger E. An unusual electrocardiogram artifact in a patient with near syncope. Journal of Electrocardiology. 2010;43(6):686–8. DOI: 10.1016/j.jelectrocard.2010.04.012

3. Takahashi K, Morioka H, Uemura S, Okura T, Sakaue T, Enomoto D et al. Aslanger’s sign in 12-lead electrocardiogram. Oxford Medical Case Reports. 2023;2023(3):omad017. DOI: 10.1093/omcr/omad017

4. Averkov O.V., Duplyakov D.V., Gilyarov M.Yu., Novikova N.A., Shakhnovich R.M., Yakovlev A.N. et al. 2020 Clinical practice guidelines for Acute ST-segment elevation myocardial infarction. Russian Journal of Cardiology. 2020;25(11):251–310. DOI: 10.15829/29/1560-4071-2020-4103

5. Krone RJ, Laskey WK, Johnson C, Kimmel SE, Klein LW, Weiner BH et al. A simplified lesion classification for predicting success and complications of coronary angioplasty. The American Journal of Cardiology. 2000;85(10):1179–84. DOI: 10.1016/S0002-9149(00)00724-4

6. Gibson CM, de Lemos JA, Murphy SA, Marble SJ, McCabe CH, Cannon CP et al. Combination Therapy With Abciximab Reduces Angiographically Evident Thrombus in Acute Myocardial Infarction: A TIMI 14 Substudy. Circulation. 2001;103(21):2550–4. DOI: 10.1161/01.CIR.103.21.2550

7. Zhang C-H, Xu Z. Where Is the Culprit Lesion in the New Electrocardiogram Pattern? JAMA Internal Medicine. 2022;182(5):547. DOI: 10.1001/jamainternmed.2022.0011