Distribution of abnormal Q waves on body surface in relation to left ventricular wall motion abnormalities in...

This study was undertaken to determine the possible one-to-one relationship between each site of asynergy of the left ventricle and the body surface area to which ensuing abnormal electrical phenomena are reflected. In 140 post-myocardial infarction (MI) patients, distribution of abnormal Q waves on the body surface was correlated with the abnormal segments of LV wall motion identified by left ventriculography (LVG). Unipolar lead electrocardiograms (ECGs) were recorded from 87 lead points over the precordium and the back with Wilson's central terminal as the reference point. Data acquisition and mapping was accomplished through a mapping system HPM 5100 microcomputer. In all cases, coronary arteriography (CAG) and LVG were performed at least 2 months after the acute episode of MI. The LVG findings were evaluated separately in seven wall segments in accordance with the American Heart Association (AHA) reporting system. Sensitivity, specificity, diagnostic accuracy, positive predictive value, and negative predictive value of the abnormal Q wave in each lead point were obtained in cases with abnormal wall motion in segments 2, 3, and 6, respectively, and in infero-posterior segments 4 or 5. Statistical analysis was performed by comparing two groups of patients with or without asynergy of each wall segment concerned. Results of the study revealed some abnormal Q areas of high diagnostic accuracy that correlated highly with the site of abnormal contractility.