Comparison of different electrocardiographic criteria for the detection of previous myocardial infarction in relation to infarct characteristics as assessed with cardiovascular magnetic resonance imaging
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KeywordsMyocardial Infarction Logistic Regression Analysis Diagnostic Accuracy Infarct Size Visual Assessment
The electrocardiogram (ECG) is often used as initial test to detect or rule out previous myocardial infarction (MI). Although different ECG-criteria with considerable heterogeneity are used for this purpose, their accuracy is not well described. We aimed to determine the diagnostic accuracy of four commonly used ECG-criteria for detecting previous MI: 1) the universal definition of previous MI, 2) the Minnesota ECG-code (MC), 3) the Selvester QRS-score, and 4) assessment by cardiologists, using delayed-enhancement cardiovascular magnetic resonance imaging (DE-CMR) as reference standard. Also the effect of different ECG and infarct characteristics on detecting previous MI were evaluated.
The 3-month follow-up ECGs of 78 first, reperfused ST-elevation MI (STEMI) patients were pooled with ECGs of 36 healthy controls. All 114 ECGs were randomly analyzed, blinded to clinical and DE-CMR data. Sensitivity, specificity, and diagnostic accuracy were determined for the universal definition, MC, Selvester QRS-score, and visual assessment by two cardiologist with >10 years of clinical experience. DE-CMR (104±11 days post MI) showed hyperenhancement matching the infarct-related artery (IRA) territory in all patients. The effect of ECG patterns and infarct characteristics on probability of MI detection was evaluated using logistic regression analysis. For anterior MI (LAD 31%), leads I, aVL, V1-V6 and for non-anterior MI (LCx 14%, RCA 55%) leads II, III, aVF, V1-V2 were evaluated.
For detecting previous MI, the time-consuming MC and visual assessment by cardiologists achieved the best and similar diagnostic accuracies. The likelihood of detecting previous MI increased with an increasing number, depth, and width of Q-waves in anterior MI and Q- or R-waves in non-anterior MI, as well as increasing infarct size and transmurality. However, a considerable number of infarctions remain undetected by all ECG-criteria.
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