Value of pathologic Q wave in surface electrocardiography in the prediction of myocardial nonviability: A cardiac magnetic resonance imaging-based study

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Abstract

In surface electrocardiography (ECG), Q wave is often considered as a sign of irreversibly scarred myocardium. Cardiac magnetic resonance (CMR) imaging is an accurate mean for the detection of myocardial viability. Herein, we study the predictive value of Q wave in nonviable (scarred) myocardium by CMR study. Retrospective analysis of the ECG and CMR data of 35 coronary artery disease patients was performed. The delayed enhancement CMR protocol was used for the detection of viability. The presence of a pathologic Q wave in surface ECG was negatively related to myocardial viability with a kappa measurement of agreement of −0.544 and P < 0.0001. Pathologic Q wave in surface ECG can be used as a simple tool for myocardial viability prediction.

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The cardiac magnetic resonance (CMR) approach to assessing myocardial viability.

Andrew E. Arai (2011)

Cardiac magnetic resonance (CMR) is a noninvasive imaging method that can determine myocardial anatomy, function, perfusion, and viability in a relative short examination. In terms of viability assessment, CMR can determine viability in a non-contrast enhanced scan using dobutamine stress following protocols comparable to those developed for dobutamine echocardiography. CMR can also determine viability with late gadolinium enhancement (LGE) methods. The gadolinium-based contrast agents used for LGE differentiate viable myocardium from scar on the basis of differences in cell membrane integrity for acute myocardial infarction. In chronic myocardial infarction, the scarred tissue enhances much more than normal myocardium due to increases in extracellular volume. LGE is well validated in pre-clinical and clinical studies that now span from almost a cellular level in animals to human validations in a large international multicenter clinical trial. Beyond infarct size or infarct detection, LGE is a strong predictor of mortality and adverse cardiac events. CMR can also image microvascular obstruction and intracardiac thrombus. When combined with a measure of area at risk like T2-weighted images, CMR can determine infarct size, area at risk, and thus estimate myocardial salvage 1-7 days after acute myocardial infarction. Thus, CMR is a well validated technique that can assess viability by gadolinium-free dobutamine stress testing or late gadolinium enhancement.

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Comparison of contrast-enhanced MRI with (18)F-FDG PET/201Tl SPECT in dysfunctional myocardium: relation to early functional outcome after surgical revascularization in chronic ischemic heart disease.

Eiji Tadamura, Masaki Yamamuro, Masashi Komeda … (2007)

Revascularization of viable myocardial segments has been shown to improve left ventricular (LV) function and long-term prognosis; however, the surgical risk is comparatively higher in patients with a low ejection fraction (EF). We compared contrast-enhanced MRI with (18)F-FDG PET/(201)Tl SPECT for myocardial viability and prediction of early functional outcome in patients with chronic coronary artery disease (CAD). Forty-one patients with chronic CAD and LV dysfunction (mean age +/- SD, 66 +/- 10 y; 32 men; mean EF +/- SD, 38% +/- 13%) referred for (18)F-FDG PET, (201)Tl-SPECT and MRI within 2 wk were included. Twenty-nine subjects underwent coronary artery bypass grafting (CABG), and LV function was reassessed by MRI before discharge (17 +/- 7 d after surgery). Two were excluded from outcome analysis (1 death due to sepsis; 1 perioperative myocardial infarction). The extent of viable myocardium by (18)F-FDG PET/(201)Tl SPECT was defined by the metabolism-perfusion mismatch or ischemia, in comparison with the extent of delayed enhancement (DE) on MRI in a 17-segment model. Segmental functional recovery was defined as improvement in the wall motion score of > or =1 on a 4-point scale. EF and LV volume change were used as global functional outcome. Three hundred ninety-four dysfunctional segments were compared, and the extent of DE on MRI correlated negatively with the viability on (18)F-FDG PET. Of 252 dysfunctional segments that were successfully revascularized, the sensitivity, specificity, positive predictive value, and negative predictive value of PET/SPECT were 60.2%, 98.7%, 76.6%, and 96.7% and of MRI were 92.2%, 44.9%, 72.4%, and 78.6% using the cutoff value of 50% DE on MRI, without significant differences in overall accuracies. In 18 subjects who underwent isolated CABG, improvement of EF (> or =5%) and reverse LV remodeling (> or =10% LV size reduction) was best predicted by the no DE on MRI, and patients with substantial nonviable myocardium on (18)F-FDG/SPECT predicted a poor early functional outcome (all P < 0.001). Accurate prediction of early functional outcome by PET/SPECT and contrast-enhanced MRI is possible.

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Can the surface electrocardiogram be used to predict myocardial viability?

J. Patel, I Mahy, M Norton … (1999)

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Journal

Journal ID (nlm-ta): J Adv Pharm Technol Res

Journal ID (iso-abbrev): J Adv Pharm Technol Res

Journal ID (publisher-id): JAPTR

Title: Journal of Advanced Pharmaceutical Technology & Research

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 2231-4040

ISSN (Electronic): 0976-2094

Publication date (Print): Oct-Dec 2018

Volume: 9

Issue: 4

Pages: 162-164

Affiliations

[1]Department of Cardiology, Mashhad University of Medical Sciences, Mashhad, Iran

[1 ]Department of Cardiology, Preventive Cardiovascular Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

[2 ]Department of Cardiology, Shahid Rajaie Cardiovascular, Medical and Research Center, Tehran, Iran

[3 ]Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Author notes

Address for correspondence: Dr. Zahra Alizadeh Sani, Shahid Rajaie Cardiovascular Medical and Research Center, Tehran, Iran. E-mail: d.alizadhh.sani@ 123456gmail.com

Article

Publisher ID: JAPTR-9-162

DOI: 10.4103/japtr.JAPTR_345_18

PMC ID: 6302687

SO-VID: 957e0d0b-30e7-493f-aec8-70b5ec4c01aa

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Value of pathologic Q wave in surface electrocardiography in the prediction of myocardial nonviability: A cardiac magnetic resonance imaging-based study

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Most cited references 11

The cardiac magnetic resonance (CMR) approach to assessing myocardial viability.

Comparison of contrast-enhanced MRI with (18)F-FDG PET/201Tl SPECT in dysfunctional myocardium: relation to early functional outcome after surgical revascularization in chronic ischemic heart disease.

Can the surface electrocardiogram be used to predict myocardial viability?

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