Electrocardiographic Q-wave "remodeling" in reperfused ST-segment elevation myocardial infarction: validation study with CMR.

Details

Serval ID
serval:BIB_FDAFCC67972C
Type
Article: article from journal or magazin.
Collection
Publications
Title
Electrocardiographic Q-wave "remodeling" in reperfused ST-segment elevation myocardial infarction: validation study with CMR.
Journal
JACC. Cardiovascular imaging
Author(s)
Florian A., Slavich M., Masci P.G., Janssens S., Bogaert J.
ISSN
1876-7591 (Electronic)
ISSN-L
1876-7591
Publication state
Published
Issued date
10/2012
Peer-reviewed
Oui
Volume
5
Number
10
Pages
1003-1013
Language
english
Notes
Publication types: Comparative Study ; Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't ; Validation Studies
Publication Status: ppublish
Abstract
The aim of this study was to evaluate the evolution in Q-wave expression during the first 5 years after a primary, successfully reperfused ST-segment elevation myocardial infarction (MI), using cardiac magnetic resonance (CMR) for infarct location, and to depict changes in infarct size and left ventricular remodeling over time.
In the absence of QRS confounders, abnormal Q waves are usually diagnostic of myocardial necrosis. It is hypothesized that Q-wave regression after MI could be related to smaller infarct sizes. Late gadolinium enhancement accurately depicts MI of any age.
Forty-six MI patients underwent electrocardiography and CMR at 1 week (baseline), 4 months, 1 year, and 5 years post-infarction. Conventional CMR parameters were analyzed, and infarct presence, location, and size were assessed using late gadolinium enhancement CMR. Infarct locations were anterior or nonanterior (inferior and/or lateral), using late gadolinium enhancement CMR as a reference. For each time point, patients were classified as having a diagnostic/nondiagnostic electrocardiogram (ECG) using the European Society of Cardiology/American College of Cardiology Foundation/American Heart Association/World Heart Federation consensus criteria for previous Q-wave infarct.
At baseline, 11 patients (23%) did not meet the criteria for Q-wave MI. Non-Q-wave infarcts were significantly smaller than Q-wave infarcts (p < 0.0001). All anterior Q-wave infarcts (n = 17) were correctly localized, whereas in 7 of 19 nonanterior Q-wave infarcts, the location or extent of the infarct was misjudged by electrocardiography. At 4-month/1-year follow-up, in 10 patients (3 anterior/7 nonanterior), the ECG became nondiagnostic. The ECG remained nondiagnostic at 5-year follow-up. A cutoff infarct size of 6.2% at 1 year yielded a sensitivity of 89% and a specificity of 74% to predict the presence or absence of Q waves.
The incidence of nondiagnostic ECGs for previous MI using the current European Society of Cardiology/American College of Cardiology Foundation/American Heart Association/World Heart Federation criteria is substantial and increases with time post-infarction from 23% immediately post-infarction to 44% at 5-year follow-up.

Keywords
Adult, Aged, Analysis of Variance, Anterior Wall Myocardial Infarction/diagnosis, Anterior Wall Myocardial Infarction/pathology, Anterior Wall Myocardial Infarction/physiopathology, Anterior Wall Myocardial Infarction/therapy, Chi-Square Distribution, Contrast Media, Electrocardiography, Europe, Female, Heart Conduction System/physiopathology, Humans, Inferior Wall Myocardial Infarction/diagnosis, Inferior Wall Myocardial Infarction/pathology, Inferior Wall Myocardial Infarction/physiopathology, Inferior Wall Myocardial Infarction/therapy, Magnetic Resonance Imaging, Male, Middle Aged, Myocardium/pathology, Percutaneous Coronary Intervention, Predictive Value of Tests, ROC Curve, Randomized Controlled Trials as Topic, Reproducibility of Results, Retrospective Studies, Stem Cell Transplantation, Time Factors, Treatment Outcome, Ventricular Remodeling
Pubmed
Web of science
Open Access
Yes
Create date
25/08/2017 21:47
Last modification date
20/08/2019 17:28
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