Accepted Manuscript New Electrocardiographic Criteria to Differentiate Acute Pericarditis and Myocardial Infarction Xavier Rossello, MD Rob F. Wiegerinck, Joan Alguersuari, MD Alfredo Bardají, MD Fernando Worner, MD Mario Sutil, MD Andreu Ferrero, Juan Cinca, MD, PhD PII:

S0002-9343(13)00975-3

DOI:

10.1016/j.amjmed.2013.11.006

Reference:

AJM 12297

To appear in:

The American Journal of Medicine

Received Date: 27 September 2013 Revised Date:

13 November 2013

Accepted Date: 13 November 2013

Please cite this article as: Rossello X, Wiegerinck RF, Alguersuari J, Bardají A, Worner F, Sutil M, Ferrero A, Cinca J, New Electrocardiographic Criteria to Differentiate Acute Pericarditis and Myocardial Infarction, The American Journal of Medicine (2013), doi: 10.1016/j.amjmed.2013.11.006. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT

CLINICAL RESEARCH STUDY

New Electrocardiographic Criteria to Differentiate Acute

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Pericarditis and Myocardial Infarction Xavier Rosselloa, MD, Rob F Wiegerincka, Joan Alguersuarib, MD, Alfredo Bardajíc, MD,

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Servicio de Cardiología, Hospital de la Santa Creu I Sant Pau, IIb-Sant Pau, Universitat

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Autonoma de Barcelona, Barcelona, Spain.

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Fernando Wornerd, MD, Mario Sutila, MD, Andreu Ferreroa, Juan Cincaa., MD, PhD.

Servicio de Cardiología, Hospital Son Espases, Palma de Mallorca, Spain.

Servicio de Cardiología, Hospital Joan XXIII, Tarragona, Spain. Servicio de Cardiología, Hospital Arnau de Vilanova, IRBLLEIDA, Lleida, Spain.

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*Corresponding author: Juan Cinca, MD, Cardiology Service, Hospital de la Santa Creu i Sant Pau, St. Antoni M. Claret 167, 08025 Barcelona, Spain. Phone: +34 935565940; Fax:

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+34 935565603; e-mail: [email protected].

Running head: ECG changes in pericarditis and infarction.

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Funding: This work was supported by a grant from the Spanish Ministry of Science and Innovation, Redes de Investigación del Instituto de Salud Carlos III [REDINSCOR RD06/0003] and Fondo Europeo de Desarrollo Regional (FEDER). Conflict of Interest: none declared. Authorship: All authors had access to the data and played a role in writing this manuscript. Keywords: Pericarditis; Myocardial infarction; ST segment, QRS complex; QT interval. 1

ACCEPTED MANUSCRIPT

ABSTRACT OBJECTIVE: Transmural myocardial ischemia induces changes in QRS complex and QT interval duration but, theoretically, these changes might not occur in acute pericarditis

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provided that the injury is not transmural. This study aims to assess whether QRS and QT duration permit to distinguish acute pericarditis and acute transmural myocardial ischemia. METHODS: Clinical records and 12-lead electrocardiogram (ECG) at x2 magnification

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were analyzed in 79 patients with acute pericarditis and in 71 with acute ST segment elevation myocardial infarction (STEMI).

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RESULTS: ECG leads with maximal ST segment elevation showed longer QRS complex and shorter QT interval than leads with isoelectric ST segment in patients with STEMI (QRS: 85.9±13.6 ms vs 81.3±10.4 ms, p=0.01; QT: 364.4±38.6 vs 370.9±37.0 ms, p=0.04) but not in patients with pericarditis (QRS: 81.5±12.5 ms vs 81.0±7.9 ms, p=0.69; QT:

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347.9±32.4 vs 347.3±35.1 ms, p=0.83). QT interval dispersion among the 12-ECG leads was greater in STEMI than in patients with pericarditis (69.8±20.8 ms vs 50.6±20.2 ms, p