Document Detail


How reliable is electrocardiography in differentiating transmural from non-transmural myocardial infarction? A study with contrast magnetic resonance imaging as gold standard.
MedLine Citation:
PMID:  15561328     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Cardiovascular magnetic resonance (CMR) using contrast enhancement allows exact determination of the site and transmural extent of myocardial infarction (MI). We evaluated whether 12-lead electrocardiography can differentiate transmural from non-transmural MI or determine the site of MI by comparing the findings with those of contrast-enhanced CMR. A total of 27 patients (59.5+/-12.9 years) with a history of MI (6.4+/-2.9 months) underwent CMR (Magnetom, Siemens, Erlangen, Germany). Cine images were acquired in the horizontal and vertical long axes and short axis by TrueFISP. Contrast-enhanced CMR images were acquired in the same axes by segmented FLASH 15 min after administration of gadolinium-DTPA (0.15 mmol/kg). This showed the MI to be transmural in 11 patients and non-transmural in 16. An electrocardiogram (ECG) was recorded in all patients before CMR. T-wave alterations, descending ST-depression, pathological Q-waves and absent R waves were more frequent in non-transmural MI than transmural MI, as defined by contrast-enhanced CMR (p> or =0.618). However, none of the differences were statistically significant. R-wave reduction, q waves and horizontal ST-depression were more frequent in transmural than in non-transmural MI (p> or =0.157). Again, the differences were not significant. The sensitivity of the ECG for MI localization was highest in inferior infarctions (85.71%), the specificity was highest in anterior infarctions (100%), the best positive predictive value (80%) was achieved for anterolateral infarctions, and the best negative predictive value for lateral infarctions (95.83%). Transmural and non-transmural MI cannot be differentiated by ECG. The ECG is most accurate in detecting anterolateral MI.
Authors:
Burkhard Sievers; Binu John; Bodo Brandts; Ulrich Franken; Marc van Bracht; Hans-Joachim Trappe
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  International journal of cardiology     Volume:  97     ISSN:  0167-5273     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2004 Dec 
Date Detail:
Created Date:  2004-11-24     Completed Date:  2005-08-16     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  417-23     Citation Subset:  IM    
Affiliation:
Department of Cardiology and Angiology, University of Bochum, Hölkeskampring 40, D-44625 Herne, Germany. burkhard.sievers@gmx.de
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MeSH Terms
Descriptor/Qualifier:
Contrast Media / pharmacology*
Electrocardiography / standards*
Gadolinium DTPA / pharmacology
Humans
Image Enhancement
Magnetic Resonance Imaging* / methods
Myocardial Infarction / diagnosis*
Chemical
Reg. No./Substance:
0/Contrast Media; 80529-93-7/Gadolinium DTPA

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