A Study On Pattern of Regional Wall Motion Abnormality In Nstemi Patients And Its Correlation With Electrocardiographic Findings In A Tertiary Care Hospital In Kolkata

Background: Non–ST-elevation myocardial infarction (NSTEMI) often presents with variable electrocardiographic and echocardiographic features. Regional wall motion abnormality (RWMA) on echocardiography reflects myocardial ischemia, but its correlation with electrocardiographic (ECG) findings in NSTEMI is not well established.

Objectives: To assess the pattern of regional wall motion abnormalities in NSTEMI patients and evaluate their correlation with ECG findings in a tertiary care hospital in eastern India.

Methods: This cross-sectional, observational study included 158 consecutive NSTEMI patients admitted between February 2023 and August 2024. Clinical data, ECG findings, and transthoracic echocardiography were analyzed. Patterns of RWMA were documented and compared across different ECG finding groups.

Results: Regional wall motion abnormality was observed in 39.9% of patients. Inferior wall hypokinesia was the most common RWMA, followed by anterior and anterolateral wall hypokinesia. Most patients were aged 61–80 years, with male predominance. The majority belonged to urban areas and had associated comorbidities and substance addiction. Chest pain was the most frequent presenting symptom. A significant proportion of patients had no ST–T changes on ECG. Among those with ECG abnormalities, ST-segment depression in leads V1–V6 was the most common finding. Statistical analysis showed no significant correlation between ECG changes and the presence or distribution of RWMA on echocardiography.

Conclusion: Approximately two-fifths of NSTEMI patients demonstrated RWMA on echocardiography, most commonly involving the inferior wall. However, ECG findings did not reliably predict the presence or location of RWMA. These results highlight the limitations of relying solely on ECG for myocardial localization in NSTEMI and underscore the importance of a multimodal diagnostic approach for accurate assessment and management.

Dr. Biswajit Majumder is a senior interventional cardiologist with over 20 years of experience. He holds MBBS, MD (Medicine), and DM (Cardiology) degrees from the University of North Bengal and University of Calcutta, and is a Professor and Head of the Department of Cardiology at R G Kar Medical College, Kolkata. A Fellow of the ACC, FSCAI, ESC, and ICC, Dr. Majumder has published extensively in national and international journals and has performed over 15,000 coronary angiographies and 1,500 angioplasties.