Author + information
- Jonathan D. Kochav,
- Peter Okin,
- Anika Afroz,
- Alfredo Renilla González,
- Thanh Nguyen,
- Yi Wang and
- Jonathan Weinsaft
LV infarct size is an adverse prognostic marker after acute MI. CMR enables highly accurate infarct quantification. Improved understanding of ECG manifestations of LV infarction is important for broadly applicable risk stratification.
CMR and ECG were prospectively acquired in pts with first ST elevation MI. Delayed enhancement (DE) CMR was quantified for LV infarct size and cine CMR for wall motion. Computerized ECG software was used to quantify potential indices of infarct size, including QRS component duration, amplitude, and Selvester score (SS). Total Q wave duration (QWD) and amplitude (QWA) were calculated as the absolute sums of data from 12 surface leads.
155 patients underwent same day ECG and CMR (29±6 days post MI). QWD on ECG correlated with DE CMR infarct size (r = 0.55) and cine CMR wall motion score (r = 0.58; both p<0.001). In multivariate analysis, infarct size independently correlated with QWD (partial r = 0.38; p<0.001) after controlling for QWA (r = −0.05; p=0.6), and QRS duration (r = 0.05; p=0.5). Both QWD and SS increased stepwise in relation to global LV infarct size (p<0.001) (Figure). In ROC analysis, QWD yielded equivalent overall performance (AUC = 0.86) to SS (AUC = 0.87; p = 0.8). At matched specificity (91%), QWD yielded equivalent sensitivity to SS for ≥ 10% LV infarction (62% vs 58% p=0.84).
Global LV infarct size increases QWD independent of QWA. Total QWD, a simple ECG parameter, yields equivalent performance to SS for CMR quantified LV infarction.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: What's New with Risk Stratification in SIHD: Biomarkers, Genes and ECG
Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical
Presentation Number: 1154-66
- 2013 American College of Cardiology Foundation