1
|
Qiu S, Liu T, Zhan Z, Li X, Liu X, Xin X, Lu J, Wu L, Wang L, Cui K, Xiu J. Revisiting the diagnostic and prognostic significance of high-frequency QRS analysis in cardiovascular diseases: a comprehensive review. Postgrad Med J 2024:qgae064. [PMID: 38796714 DOI: 10.1093/postmj/qgae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/07/2024] [Accepted: 04/19/2024] [Indexed: 05/28/2024]
Abstract
Cardiovascular diseases (CVDs) present a significant global public health threat, contributing to a substantial number of cases involving morbidity and mortality. Therefore, the early and accurate detection of CVDs plays an indispensable role in enhancing patient outcomes. Decades of extensive research on electrocardiography at high frequencies have yielded a wealth of knowledge regarding alterations in the QRS complex during myocardial ischemia, as well as the methodologies to assess and quantify these changes. In recent years, the analysis of high-frequency QRS (HF-QRS) components has emerged as a promising non-invasive approach for diagnosing various cardiovascular conditions. Alterations in HF-QRS amplitude and morphology have demonstrated remarkable sensitivity as diagnostic indicators for myocardial ischemia, often surpassing measures of ST-T segment changes. This comprehensive review aims to provide an intricate overview of the current advancements, challenges, and prospects associated with HF-QRS analysis in the field of CVDs.
Collapse
Affiliation(s)
- Shifeng Qiu
- Department of Cardiology, Southern Medical University, Nanfang Hospital, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Nanfang Hospital, Guangzhou 510515, China
- State Key Laboratory of Organ Failure Research, Southern Medical University, Nanfang Hospital, Guangzhou 510515, China
| | - Tinghui Liu
- Department of Cardiology, Southern Medical University, Nanfang Hospital Zengcheng Campus, Guangzhou 511340, China
| | - Zijin Zhan
- Department of Cardiology, Southern Medical University, Nanfang Hospital Zengcheng Campus, Guangzhou 511340, China
| | - Xue Li
- Department of Gastroenterology, Southern Medical University, Nanfang Hospital, Guangzhou 510515, China
| | - Xuewei Liu
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Nanfang Hospital, Guangzhou 510515, China
- The Tenth Affiliated Hospital of Southern Medical University (Dongguan People's Hospital), Southern Medical University or The First School of Clinical Medicine, Southern Medical University, Dongguan 523018, China
| | - Xiaoyu Xin
- Department of Cardiology, Southern Medical University, Nanfang Hospital, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Nanfang Hospital, Guangzhou 510515, China
- State Key Laboratory of Organ Failure Research, Southern Medical University, Nanfang Hospital, Guangzhou 510515, China
| | - Junyan Lu
- Department of Cardiology, Southern Medical University, Nanfang Hospital, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Nanfang Hospital, Guangzhou 510515, China
- State Key Laboratory of Organ Failure Research, Southern Medical University, Nanfang Hospital, Guangzhou 510515, China
| | - Lipei Wu
- Department of Cardiology, Southern Medical University, Nanfang Hospital Zengcheng Campus, Guangzhou 511340, China
| | - Li Wang
- Department of General Internal Medicine Unit One, Southern Medical University, Nanfang Hospital Zengcheng Campus, Guangzhou 511340, China
| | - Kai Cui
- Department of Cardiology, Southern Medical University, Nanfang Hospital, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Nanfang Hospital, Guangzhou 510515, China
- State Key Laboratory of Organ Failure Research, Southern Medical University, Nanfang Hospital, Guangzhou 510515, China
| | - Jiancheng Xiu
- Department of Cardiology, Southern Medical University, Nanfang Hospital, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Nanfang Hospital, Guangzhou 510515, China
- State Key Laboratory of Organ Failure Research, Southern Medical University, Nanfang Hospital, Guangzhou 510515, China
| |
Collapse
|
2
|
Kersten J, Eberhardt N, Prasad V, Keßler M, Markovic S, Mörike J, Nita N, Stephan T, Tadic M, Tesfay T, Rottbauer W, Buckert D. Non-invasive Imaging in Patients With Chronic Total Occlusions of the Coronary Arteries-What Does the Interventionalist Need for Success? Front Cardiovasc Med 2021; 8:713625. [PMID: 34527713 PMCID: PMC8435679 DOI: 10.3389/fcvm.2021.713625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/06/2021] [Indexed: 10/26/2022] Open
Abstract
Chronic total occlusion (CTO) of coronary arteries is a common finding in patients with known or suspected coronary artery disease (CAD). Although tremendous advances have been made in the interventional treatment of CTOs over the past decade, correct patient selection remains an important parameter for achieving optimal results. Non-invasive imaging can make a valuable contribution. Ischemia and viability, two major factors in this regard, can be displayed using echocardiography, single-photon emission tomography, positron emission tomography, computed tomography, and cardiac magnetic resonance imaging. Each has its own strengths and weaknesses. Although most have been studied in patients with CAD in general, there is an increasing number of studies with positive preselectional factors for patients with CTOs. The aim of this review is to provide a structured overview of the current state of pre-interventional imaging for CTOs.
Collapse
Affiliation(s)
- Johannes Kersten
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Nina Eberhardt
- Department for Nuclear Medicine, University of Ulm, Ulm, Germany
| | - Vikas Prasad
- Department for Nuclear Medicine, University of Ulm, Ulm, Germany
| | - Mirjam Keßler
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Sinisa Markovic
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Johannes Mörike
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Nicoleta Nita
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Tilman Stephan
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Marijana Tadic
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Temsgen Tesfay
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | | | - Dominik Buckert
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| |
Collapse
|
3
|
Markendorf S, Benz DC, Messerli M, Grossmann M, Giannopoulos AA, Patriki D, Fuchs TA, Gräni C, Pazhenkottil AP, Buechel RR, Kaufmann PA, Gaemperli O. Value of 12-lead electrocardiogram to predict myocardial scar on FDG PET in heart failure patients. J Nucl Cardiol 2021; 28:1364-1373. [PMID: 31399902 DOI: 10.1007/s12350-019-01841-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/17/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE A surface 12-lead electrocardiogram (ECG) is widely available, fast, inexpensive, and safe. However, its value to predict a true myocardial scar in patients with ischemic cardiomyopathy (ICM) has not been studied extensively yet. This study was conducted to assess whether Q waves on resting surface 12-lead ECG are predictive of non-viable myocardium in patients with ICM. METHODS We analyzed resting ECGs of 149 patients with ICM undergoing cardiac positron emission tomography (PET) with 13N-ammonia (NH3) and 18F-fluorodeoxyglucose (FDG) at our institution. Pathological Q waves and QS complexes were assigned to one of three coronary artery territories and compared to the PET findings. Myocardial scar was defined as 2 or more contiguous myocardial segments with an average (matched) reduction of NH3 and FDG uptake <50% of the maximum value. RESULTS Pathological Q waves had a sensitivity and specificity of 70% and 40%, respectively, and a PPV and NPV of 37% and 73%, respectively, to detect myocardial scar on FDG PET. For QS complexes, sensitivity and specificity were 46% and 59%, respectively, and PPV and NPV were 36% and 68%, respectively. Sensitivity was lower, but specificity was significantly higher in both the LCX and RCA compared to the LAD territory (p<0.001), particularly for QS complexes. CONCLUSION Pathological Q waves on resting 12-lead ECG have poor or at best moderate sensitivity and specificity to detect myocardial scar on FDG PET. These findings support the use of more advanced imaging techniques to assess myocardial viability in ICM.
Collapse
Affiliation(s)
- Susanne Markendorf
- Cardiac Imaging, Nuclear Medicine Department, University Hospital Zurich, Zurich, Switzerland.
| | - Dominik C Benz
- Cardiac Imaging, Nuclear Medicine Department, University Hospital Zurich, Zurich, Switzerland
| | - Michael Messerli
- Cardiac Imaging, Nuclear Medicine Department, University Hospital Zurich, Zurich, Switzerland
| | - Marvin Grossmann
- Cardiac Imaging, Nuclear Medicine Department, University Hospital Zurich, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Cardiac Imaging, Nuclear Medicine Department, University Hospital Zurich, Zurich, Switzerland
| | - Dimitri Patriki
- Cardiac Imaging, Nuclear Medicine Department, University Hospital Zurich, Zurich, Switzerland
| | - Tobias A Fuchs
- Cardiac Imaging, Nuclear Medicine Department, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Gräni
- Cardiac Imaging, Nuclear Medicine Department, University Hospital Zurich, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Cardiac Imaging, Nuclear Medicine Department, University Hospital Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Cardiac Imaging, Nuclear Medicine Department, University Hospital Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Cardiac Imaging, Nuclear Medicine Department, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Gaemperli
- Cardiac Imaging, Nuclear Medicine Department, University Hospital Zurich, Zurich, Switzerland
- HeartClinic Hirslanden, Witellikerstrasse 40, 8032, Zurich, Switzerland
| |
Collapse
|
4
|
Patel H, Doppalapudi H, Hage FG. Myocardial infarction assessment by surface electrocardiography. J Nucl Cardiol 2021; 28:1374-1377. [PMID: 31646471 DOI: 10.1007/s12350-019-01903-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Haren Patel
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, LHRB 326, 701 19th Street South, Birmingham, AL, 35294, USA.
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
| | - Harish Doppalapudi
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, LHRB 326, 701 19th Street South, Birmingham, AL, 35294, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, LHRB 326, 701 19th Street South, Birmingham, AL, 35294, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| |
Collapse
|
5
|
Arjmand A, Eshraghi A, Sani ZA, Firouzi A, Sanati HR, Nezami H, Jalalyazdi M, Ghiasi SS. Value of pathologic Q wave in surface electrocardiography in the prediction of myocardial nonviability: A cardiac magnetic resonance imaging-based study. J Adv Pharm Technol Res 2019; 9:162-164. [PMID: 30637236 PMCID: PMC6302687 DOI: 10.4103/japtr.japtr_345_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In surface electrocardiography (ECG), Q wave is often considered as a sign of irreversibly scarred myocardium. Cardiac magnetic resonance (CMR) imaging is an accurate mean for the detection of myocardial viability. Herein, we study the predictive value of Q wave in nonviable (scarred) myocardium by CMR study. Retrospective analysis of the ECG and CMR data of 35 coronary artery disease patients was performed. The delayed enhancement CMR protocol was used for the detection of viability. The presence of a pathologic Q wave in surface ECG was negatively related to myocardial viability with a kappa measurement of agreement of −0.544 and P < 0.0001. Pathologic Q wave in surface ECG can be used as a simple tool for myocardial viability prediction.
Collapse
Affiliation(s)
- Ashkan Arjmand
- Department of Cardiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Eshraghi
- Department of Cardiology, Preventive Cardiovascular Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Alizadeh Sani
- Department of Cardiology, Shahid Rajaie Cardiovascular, Medical and Research Center, Tehran, Iran
| | - Ata Firouzi
- Department of Cardiology, Shahid Rajaie Cardiovascular, Medical and Research Center, Tehran, Iran
| | - Hamid Reza Sanati
- Department of Cardiology, Shahid Rajaie Cardiovascular, Medical and Research Center, Tehran, Iran
| | - Hadi Nezami
- Department of Cardiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Jalalyazdi
- Department of Cardiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shirin Sadat Ghiasi
- Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
6
|
Characterization of viability, scarring and hibernation of the myocardium supplied by epicardial coronary arteries with low flow grades. Nucl Med Commun 2017; 38:657-665. [DOI: 10.1097/mnm.0000000000000683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
7
|
AlMohammad A, Norton MY, Welch AE, Sharp PF, Walton S. Gated metabolic myocardial imaging, a surrogate for dual perfusion-metabolism imaging by positron emission tomography. Open Heart 2017; 4:e000581. [PMID: 28878945 PMCID: PMC5574422 DOI: 10.1136/openhrt-2016-000581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/17/2017] [Accepted: 06/13/2017] [Indexed: 11/15/2022] Open
Abstract
Objective Perfusion-metabolism mismatch pattern on positron emission tomography (PET) predicts hibernating myocardium. We assess the ECG-gated metabolic PET as a surrogate for the perfusion-metabolism mismatch pattern on PET imaging. Methods 13N-Ammonia (NH3) and 18F-fluorodeoxyglucose (FDG) are respectively perfusion and metabolism PET tracers. We used ECG gating to acquire FDG-PET to collect wall thickening (mechanical) data. These allow detection of metabolic activity in regions with reduced contraction (metabolism-mechanical mismatch pattern). We had two data sets on each patient: perfusion-metabolism and metabolism-mechanical data sets. We tested the hypothesis that metabolism-mechanical pattern on PET could predict perfusion-metabolism mismatch pattern. Results We studied 55 patients (48 males), mean age 62 years. All were in sinus rhythm, and had impaired left ventricular contraction. Perfusion-metabolism mismatch pattern was found in 26 patients. Metabolism-mechanical mismatch pattern was found in 25 patients. The results were concordant in 52 patients (95%). As a surrogate for perfusion-metabolism mismatch pattern, demonstration of metabolism-mechanical mismatch pattern is highly sensitive (92%) and specific (97%). In this cohort, the positive and negative predictive accuracy of the new method are 96% and 93%, respectively. Conclusion Metabolism-mechanical mismatch pattern could predict perfusion-metabolism mismatch pattern in patients with myocardial viability criteria on PET. Prospective validation against the gold standard of improved myocardial contraction after revascularisation is needed.
Collapse
Affiliation(s)
- Abdallah AlMohammad
- South Yorkshire Cardiothoracic Centre, Chesterman Wing, Northern General Hospital, Sheffield, UK
| | - Murdoch Y Norton
- The Department of Medical Physics and Bio-medical Engineering, Aberdeen University, Aberdeen, UK
| | - Andrew E Welch
- The Department of Medical Physics and Bio-medical Engineering, Aberdeen University, Aberdeen, UK
| | - Peter F Sharp
- The Department of Medical Physics and Bio-medical Engineering, Aberdeen University, Aberdeen, UK
| | - Stephen Walton
- The Department of Cardiology, Aberdeen Royal Infirmary, Grampian University Hospitals NHS Trust, Aberdeen, UK
| |
Collapse
|
8
|
Myocardial Viability: From Proof of Concept to Clinical Practice. Cardiol Res Pract 2016; 2016:1020818. [PMID: 27313943 PMCID: PMC4903128 DOI: 10.1155/2016/1020818] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/04/2016] [Indexed: 11/20/2022] Open
Abstract
Ischaemic left ventricular (LV) dysfunction can arise from myocardial stunning, hibernation, or necrosis. Imaging modalities have become front-line methods in the assessment of viable myocardial tissue, with the aim to stratify patients into optimal treatment pathways. Initial studies, although favorable, lacked sufficient power and sample size to provide conclusive outcomes of viability assessment. Recent trials, including the STICH and HEART studies, have failed to confer prognostic benefits of revascularisation therapy over standard medical management in ischaemic cardiomyopathy. In lieu of these recent findings, assessment of myocardial viability therefore should not be the sole factor for therapy choice. Optimization of medical therapy is paramount, and physicians should feel comfortable in deferring coronary revascularisation in patients with coronary artery disease with reduced LV systolic function. Newer trials are currently underway and will hopefully provide a more complete understanding of the pathos and management of ischaemic cardiomyopathy.
Collapse
|
9
|
Lateef F. Time-critical AMI Detection: A novel and fast technique using the 12-lead ECG. JOURNAL OF ACUTE DISEASE 2014. [DOI: 10.1016/s2221-6189(14)60065-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
10
|
Davis TME, Coleman RL, Holman RR. Prognostic significance of silent myocardial infarction in newly diagnosed type 2 diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS) 79. Circulation 2013; 127:980-7. [PMID: 23362315 DOI: 10.1161/circulationaha.112.000908] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to determine the prevalence of silent myocardial infarction (SMI) in people with newly diagnosed type 2 diabetes mellitus and its relationships to future myocardial infarction (MI) and all-cause mortality. METHODS AND RESULTS We examined data from the 5102 patients in the 30-year UK Prospective Diabetes Study (UKPDS) and used Cox proportional hazards regression to examine outcomes by SMI status. Of 1967 patients with complete baseline data, 326 (16.6%) had ECG evidence of SMI (Minnesota codes 1.1 or 1.2) at enrollment. Those with SMI were more likely to be older, female, sedentary, and nonsmokers compared with those without SMI. Their mean blood pressure was greater despite more intensive antihypertensive treatment; they were more likely to be taking aspirin and lipid-lowering therapy; and they had a greater prevalence of microangiopathy. Fully adjusted hazard ratios for those with versus those without SMI in multivariate models that included UKPDS Risk Engine variables were 1.58 (95% confidence interval, 1.22-2.05) for fatal MI and 1.31 (95% confidence interval, 1.10-1.56) for all-cause mortality. Hazard ratios for first fatal or nonfatal MI and for first nonfatal MI were nonsignificant. The net reclassification index showed no improvement when SMI was added to these models, and the integrated discrimination index showed that SMI marginally improved the prediction of fatal MI and all-cause mortality. CONCLUSIONS About 1 in 6 UKPDS patients with newly diagnosed type 2 diabetes mellitus had evidence of SMI, which was independently associated with an increased risk of fatal MI and all-cause mortality. However, identification of SMI does not add substantively to current UKPDS Risk Engine predictive variables. CLINICAL TRIAL REGISTRATION URL: http://www.controlled-trials.com. Identifier: ISRCTN number 75451837.
Collapse
Affiliation(s)
- Timothy M E Davis
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia.
| | | | | | | |
Collapse
|
11
|
Kondola S, Davis WA, Dembo LG, Davis TME. A cardiac magnetic resonance imaging study of electrocardiographic Q waves in type 2 diabetes: the Fremantle Diabetes Study. Diabetes Res Clin Pract 2008; 82:87-92. [PMID: 18678430 DOI: 10.1016/j.diabres.2008.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2008] [Revised: 06/22/2008] [Accepted: 06/30/2008] [Indexed: 11/28/2022]
Abstract
To investigate the evolution and significance of Q waves in type 2 diabetes, we studied 36 patients of mean (+/-S.D.) age 69.9+/-7.1 years from the longitudinal observational Fremantle Diabetes Study (FDS). All had (i) neither history/symptoms of coronary heart disease (CHD) nor pathological Q waves at FDS recruitment between 1993 and 1996, (ii) five consecutive annual assessments by FDS close-out in 2001, and (iii) contrast-enhanced cardiac magnetic resonance imaging in 2005. At this latter assessment, there were (i) 9 with no history of CHD or Q waves during follow-up (Group 1), (ii) 13 with Q waves on >/=1 electrocardiogram but no CHD history/symptoms (Group 2), and (iii) 14 with CHD history/symptoms irrespective of electrocardiographic status (Group 3). Of 20 episodes of new Q waves in 17 Group 2 or Group 3 patients during FDS follow-up, 17 (85%) resolved within 2 years. A myocardial infarction (MI) was detected by CMR in three patients (8.3%; one subendocardial in Groups 1 and 3, one non-full-thickness in Group 3) but these did not correlate with electrocardiographic appearances. Q waves may have unreliable pathological significance in type 2 diabetes, including as a marker of silent MI.
Collapse
Affiliation(s)
- Sanjana Kondola
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | | | | | | |
Collapse
|
12
|
Asch FM, Shah S, Rattin C, Swaminathan S, Fuisz A, Lindsay J. Lack of sensitivity of the electrocardiogram for detection of old myocardial infarction: a cardiac magnetic resonance imaging study. Am Heart J 2006; 152:742-8. [PMID: 16996851 DOI: 10.1016/j.ahj.2006.02.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Accepted: 02/05/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND The presence of Q waves in the electrocardiogram (ECG) has been used as a marker of prior myocardial infarction (MI). Its accuracy, however, is uncertain. The purpose of this study is to determine the accuracy of an ECG to detect prior MI compared with a novel criterion standard. METHODS This study conducted retrospective inclusion with de novo analysis of ECG and cardiac magnetic resonance (CMR) by independent blinded readers in a single-institution setting. The population consisted of a consecutive sample of 146 patients referred for CMR for evaluation of myocardial viability and necrosis. Q/QS waves on ECG were defined as per Minnesota Code criteria. Myocardial scar was quantified and localized by CMR delayed contrast hyperenhancement and assumed as criterion standard. Sensitivity, specificity, and predictive values of ECG were calculated for different scar sizes (>1%, >15%, and >30% of the myocardium) and location (global, anterior, inferior, and lateral walls). RESULTS Sensitivity was 48.4%; specificity, 83.5; positive predictive accuracy, 72.0%; and negative predictive accuracy, 64.2%. Sensitivity improved when only large infarcts were considered (64.2%), but specificity decreased to 72.7%. Sensitivity for detecting isolated anterior or inferior wall scars was similar, but isolated lateral wall scar was rarely identified (14.3%). When all 3 walls were involved, sensitivity was still low at 57.9%. CONCLUSIONS The lack of sensitivity and the resulting low negative predictive value of Q/QS criteria seriously limit its accuracy as a marker of prior MI.
Collapse
Affiliation(s)
- Federico M Asch
- Section of Cardiology, Department of Internal Medicine, Washington Hospital Center, Washington, DC, USA
| | | | | | | | | | | |
Collapse
|
13
|
Sgarbossa EB, Barold SS, Pinski SL, Wagner GS, Pahlm O. Twelve-lead electrocardiogram: The advantages of an orderly frontal lead display including lead −aVR. J Electrocardiol 2004; 37:141-7. [PMID: 15286926 DOI: 10.1016/j.jelectrocard.2004.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It is possible that efforts in ECG review by both young experienced clinicians are currently discouraged-and risk to be completely dismissed-by the conventional (ie, disorderly) display of the frontal plane leads, with lead aVR at -150 degrees. METHODS We reviewed studies on the usefulness of leads aVR and -aVR as well as on the history of the frontal leads in electrocardiography. RESULTS Lead aVR and particularly, lead -aVR, provide useful information when systematically analyzed. In addition, if lead -aVR is examined in its anatomically logical sequence, ie, aVL, I, -aVR, II, aVF, and III, the frontal plane of the 12-lead ECG is more easily understood. This "panoramic" or "orderly" display is in common use in countries such as Sweden, but it is rarely seen in the United States. CONCLUSIONS ECG interpretation would be enhanced by displaying the limb leads in an orderly arrangement that starts with lead aVL and ends with lead III, and many ECG changes would be ideally displayed by a lead -aVR at 30 degrees.
Collapse
Affiliation(s)
- Elena B Sgarbossa
- Department of Internal Medicine/Cardiology, Rush Presbyterian-St. Luke's Medical Center, Chicago, IL, USA
| | | | | | | | | |
Collapse
|