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. 1999 Dec;82(6):663–667. doi: 10.1136/hrt.82.6.663

Can the surface electrocardiogram be used to predict myocardial viability?

A Al-Mohammad 1, M Norton 1, I Mahy 1, J Patel 1, A Welch 1, P Mikecz 1, S Walton 1
PMCID: PMC1729205  PMID: 10573488

Abstract

OBJECTIVE—To investigate whether QRS morphology on the surface ECG can be used to predict myocardial viability.
DESIGN—ECGs of 58 patients with left ventricular impairment undergoing positron emission tomography (PET) were studied. 13N-Ammonia (NH3) and 18F-fluorodeoxyglucose (FDG) were the perfusion and the metabolic markers, respectively. The myocardium is scarred when the uptake of both markers is reduced (matched defect). Reduced NH3 uptake with persistent FDG uptake (mismatched defect) represents hibernating myocardium. First, the relation between pathological Q waves and myocardial scarring was investigated. Second, the significance of QR and QS complexes in predicting hibernating myocardium was determined.
RESULTS—As a marker of matched PET defects, Q waves were specific (79%) but not sensitive (41%), with a 77% positive predictive accuracy and a poor (43%) negative predictive accuracy. The mean size of the matched PET defect associated with Q waves was 20% of the left ventricle. This was not significantly different from the size of the matched PET defects associated with no Q waves (18%). Among the regions associated with Q waves on the ECG, there were 16 regions with QR pattern (group A) and 23 regions with QS pattern (group B). The incidence of mismatched PET defects was 19% of group A and 30% of group B (NS).
CONCLUSIONS—Q waves are specific but not sensitive markers of matched defects representing scarred myocardium. Q waves followed by R waves are not more likely to be associated with hibernating myocardium than QS complexes.


Keywords: electrocardiography; myocardial viability; positron emission tomography; myocardial scarring

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Figure 1  .

Figure 1  

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Two polar maps representing the left ventricle. Each is divided into five regions. The numbers represent the following left ventricular regions: 1, the apex; 2, the septum; 3, the anterior wall; 4, the lateral wall; 5, the inferior wall. (A) The perfusion polar map. This shows an inferolateral defect (arrowhead). (B) The metabolic polar map. This shows a matching metabolic defect in the inferolateral region (arrowhead). Therefore, the patient has a matched inferolateral defect suggestive of myocardial scarring in that region. (The colour scale is representative of the radioactive activity in the region, with yellow being the highest count.)

Figure 2  .

Figure 2  

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The importance of Q wave as a marker of myocardial scarring. The bars represent the patients with (group 1) and without (group 2) pathological Q waves on their surface ECG.

Figure 3  .

Figure 3  

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R after Q wave as a marker of hibernating myocardium. The bars are representative of two groups of patients with pathological Q waves on their surface ECGs. Group A has R after Q waves, and group B has no R waves after Q waves.

Selected References

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