Can the surface electrocardiogram be used to predict myocardial viability?

A Al-Mohammad, M Y Norton, I R Mahy, J C Patel, A E Welch, P Mikecz, S Walton

Research output: Contribution to journalArticle

16 Citations (Scopus)

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. N-13-Ammonia (NH3) and F-18- 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 EGG, 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.

Original languageEnglish
Pages (from-to)663-667
Number of pages5
JournalHeart
Volume82
Publication statusPublished - 1999

Keywords

  • electrocardiography
  • myocardial viability
  • positron emission tomography
  • myocardial scarring
  • POSITRON EMISSION TOMOGRAPHY
  • LEFT-VENTRICULAR DYSFUNCTION
  • Q-WAVE
  • HIBERNATING MYOCARDIUM
  • REGIONAL PERFUSION
  • WALL-MOTION
  • INFARCTION
  • THROMBOLYSIS
  • IMPROVEMENT

Cite this

Al-Mohammad, A., Norton, M. Y., Mahy, I. R., Patel, J. C., Welch, A. E., Mikecz, P., & Walton, S. (1999). Can the surface electrocardiogram be used to predict myocardial viability? Heart, 82, 663-667.

Can the surface electrocardiogram be used to predict myocardial viability? / Al-Mohammad, A ; Norton, M Y ; Mahy, I R ; Patel, J C ; Welch, A E ; Mikecz, P ; Walton, S .

In: Heart, Vol. 82, 1999, p. 663-667.

Research output: Contribution to journalArticle

Al-Mohammad, A, Norton, MY, Mahy, IR, Patel, JC, Welch, AE, Mikecz, P & Walton, S 1999, 'Can the surface electrocardiogram be used to predict myocardial viability?', Heart, vol. 82, pp. 663-667.
Al-Mohammad A, Norton MY, Mahy IR, Patel JC, Welch AE, Mikecz P et al. Can the surface electrocardiogram be used to predict myocardial viability? Heart. 1999;82:663-667.
Al-Mohammad, A ; Norton, M Y ; Mahy, I R ; Patel, J C ; Welch, A E ; Mikecz, P ; Walton, S . / Can the surface electrocardiogram be used to predict myocardial viability?. In: Heart. 1999 ; Vol. 82. pp. 663-667.
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title = "Can the surface electrocardiogram be used to predict myocardial viability?",
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. N-13-Ammonia (NH3) and F-18- 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 EGG, 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, POSITRON EMISSION TOMOGRAPHY, LEFT-VENTRICULAR DYSFUNCTION, Q-WAVE, HIBERNATING MYOCARDIUM, REGIONAL PERFUSION, WALL-MOTION, INFARCTION, THROMBOLYSIS, IMPROVEMENT",
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TY - JOUR

T1 - Can the surface electrocardiogram be used to predict myocardial viability?

AU - Al-Mohammad, A

AU - Norton, M Y

AU - Mahy, I R

AU - Patel, J C

AU - Welch, A E

AU - Mikecz, P

AU - Walton, S

PY - 1999

Y1 - 1999

N2 - 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. N-13-Ammonia (NH3) and F-18- 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 EGG, 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.

AB - 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. N-13-Ammonia (NH3) and F-18- 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 EGG, 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.

KW - electrocardiography

KW - myocardial viability

KW - positron emission tomography

KW - myocardial scarring

KW - POSITRON EMISSION TOMOGRAPHY

KW - LEFT-VENTRICULAR DYSFUNCTION

KW - Q-WAVE

KW - HIBERNATING MYOCARDIUM

KW - REGIONAL PERFUSION

KW - WALL-MOTION

KW - INFARCTION

KW - THROMBOLYSIS

KW - IMPROVEMENT

M3 - Article

VL - 82

SP - 663

EP - 667

JO - Heart

JF - Heart

SN - 1355-6037

ER -