Anil Kumar Taneja1, Sajad Hayat1, Jonathan Swinburn1, Roxy Senior2. 1. Cardiac Research, Department of Cardiology, Northwick Park Hospital, Harrow HA1 3UJ, Middlesex University, London, United Kingdom. 2. Cardiac Research, Department of Cardiology, Northwick Park Hospital, Harrow HA1 3UJ, Middlesex University, London, United Kingdom. Electronic address: roxysenior@cardiac-research.org.
Abstract
BACKGROUND: Controversy exists regarding the significance of pathological 'Q' waves on electrocardiography (ECG) following established acute myocardial infarction (AMI) in predicting non-viable myocardium. AIM: The aim of the study was to ascertain the reliability of 'Q' waves on ECG to predict myocardial viability following AMI. METHODS: 176 patients underwent both ECG and DSE, at a mean of 4.9 days post AMI. Non-viability on ECG and DSE was defined as mentioned below. Both ECG and DSE were used to evaluate 352 (176 anterior and 176 inferior) myocardial territories for viability. RESULTS: The positive predictive value and the negative predictive value of 'Q' waves on ECG to predict non-viable myocardium were 43% and 85% respectively. The sensitivity for ECG to detect non-viable myocardium was rather low for both anterior and inferior 'Q' waves (64% and 65% respectively), and, the specificity was as well not high enough (72% for anterior and 69% for inferior). CONCLUSION: The presence of extensive 'Q' waves does not predict non-viable myocardium. Whereupon, absence of 'Q' waves predicts the presence of viable myocardium for inferior territory but this is relatively less reliable for anterior territory. Myocardial viability should be sought in patients with extensive 'Q' waves and in unclear anterior territories.
BACKGROUND: Controversy exists regarding the significance of pathological 'Q' waves on electrocardiography (ECG) following established acute myocardial infarction (AMI) in predicting non-viable myocardium. AIM: The aim of the study was to ascertain the reliability of 'Q' waves on ECG to predict myocardial viability following AMI. METHODS: 176 patients underwent both ECG and DSE, at a mean of 4.9 days post AMI. Non-viability on ECG and DSE was defined as mentioned below. Both ECG and DSE were used to evaluate 352 (176 anterior and 176 inferior) myocardial territories for viability. RESULTS: The positive predictive value and the negative predictive value of 'Q' waves on ECG to predict non-viable myocardium were 43% and 85% respectively. The sensitivity for ECG to detect non-viable myocardium was rather low for both anterior and inferior 'Q' waves (64% and 65% respectively), and, the specificity was as well not high enough (72% for anterior and 69% for inferior). CONCLUSION: The presence of extensive 'Q' waves does not predict non-viable myocardium. Whereupon, absence of 'Q' waves predicts the presence of viable myocardium for inferior territory but this is relatively less reliable for anterior territory. Myocardial viability should be sought in patients with extensive 'Q' waves and in unclear anterior territories.