Clinical InvestigationImaging and Diagnostic TestingLack of sensitivity of the electrocardiogram for detection of old myocardial infarction: A cardiac magnetic resonance imaging study
Section snippets
Methods
The institutional review board of the Medstar Research Institute (Washington, DC) approved the protocol as a review of an existing database. All patient identifiers were removed before analysis.
Results
One hundred forty-six consecutive patients were reviewed. Seven were excluded because of left bundle branch block. The remaining 139 patients were analyzed. Sixty-six (47.5%) patients had a myocardial scar. Forty-four (31.7%) had MC Q/QS criteria. Baseline characteristics are shown in Table I. The mean time between CMR and ECG was 2.8 days. In 13 (20%) of the 66 patients with myocardial scar, CMR was performed within 7 days of MI. In the remaining 53 (80%), the age of the MI was greater than 7
Discussion
Electrocardiogram is accepted in clinical practice as a screening tool for detecting patients with prior MI. Despite its widespread clinical use, only a limited number of studies are available comparing ECG findings with the presence of myocardial necrosis or scar. The major finding of this study was the low sensitivity of MC Q/QS criteria for detecting myocardial scar represented by DCHE on CMR. One third of the largest scars, those involving more than 30% of the total ventricular volume, were
Conclusions
We conclude that the use of MC criteria for pathologic Q and QS waves to detect prior MI is importantly limited by a relatively low sensitivity. Moreover, these findings are in keeping with the long-held understanding that lateral wall MI is often unrecognized by the ECG.
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