Can the surface electrocardiogram be used to predict myocardial viability?
A Al-Mohammada, M Y Nortonb, I R Mahya, J C Patela, A E Welchb, P Mikeczb, S Waltona
a Cardiac Department,
Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK, b The PET Unit, Department of Bio-medical Physics
and Bio-engineering, Aberdeen University, Foresterhill, Aberdeen, UK
Correspondence to: Dr Al-Mohammad
Accepted for publication 1 July 1999
OBJECTIVE
To
investigate whether QRS morphology on the surface ECG can be used to
predict myocardial viability.
DESIGNECGs 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.
RESULTSAs 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).
CONCLUSIONSQ 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
© 1999 by Heart
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