- Poster presentation
- Open Access
Electrocardiographic markers of myocardial infarction size, transmural extent, and extent of nonviable myocardium - comparison to CMR
© Lee et al. 2016
- Published: 27 January 2016
- Myocardial Infarction
- Cardiovascular Magnetic Resonance
- Multivariate Linear Regression
- Left Bundle Branch Block
- Cardiovascular Magnetic Resonance Imaging
Myocardial infarction (MI) size is an important determinant of mortality in post-MI patients, but the current gold standard test, cardiovascular magnetic resonance imaging (CMR), is expensive and not widely available. We sought to determine whether information from a readily available standard 12-lead electrocardiogram (ECG) could be utilized to estimate infarct size, extent of transmural infarction, and extent of nonviable myocardium on CMR.
Patients with a clinical history of MI enrolled in the DETERMINE and PREDETERMINE Trial and Registry (ClinicalTrials.gov ID NCT02164058, NCT01114269) were included. Patients with left bundle branch block were excluded. ECG's were analyzed for candidate ECGs markers, which may signify the presence and extent of MI [Q waves (Qw), fragmented QRS (fQRS), and T wave inversion (TWI)]. Contiguous Qw (cQw MI) and TWI (cTWI) required involvement of two leads in a coronary distribution. Qw, fQRS, and TWI in individual leads were also examined. CMR infarct mass as a percentage total left ventricular (LV) mass (Infarct%) and LV ejection fraction (LVEF) were planimetered from late gadolinium enhanced (LGE) and cine short axis stacks, respectively. LGE images were also scored visually on a 17-segment model for the total number of segments with MI that were transmural at any point (Transmural Segments) and the total number of segments that were >50% infarcted (Nonviable Segments).
Qw, fQRS, and TWI on ECG are independently associated with an increase in MI% measured by CMR in patients with a history of MI. Patients with these ECG markers also have a greater extent of transmural MI and nonviable myocardium, which increases with each additional marker seen on ECG. ECG estimates of MI size and extent may be useful to guide further risk stratification for sudden cardiac death.
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