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Q wave area for stratification of global left ventricular infarct size: comparison to conventional ECG assessment
Jonathan W Weinsaft1, Jonathan D Kochav, Anika Afroz
1aDepartment of Medicine, Greenberg Cardiology Division, Weill Cornell Medical College, New York, New York bDuke University School of Medicine, Durham, North Carolina, USA.
Objectives:
Left ventricular (LV) infarct size is a prognostic determinant after acute myocardial infarction (AMI). ECG data have been used to measure infarct size, but conventional approaches use multiparametric algorithms that have limited clinical applicability. This study tested a novel ECG approach - based solely on Q wave area - for calculation of LV infarct size.
Methods:
Serial 12-lead ECGs were performed in AMI patients. Computerized software was used to quantify Q wave area (summed across surface ECG leads) and Selvester QRS-score components. ECG analysis was compared to the reference of myocardial infarct size quantified by delayed enhancement cardiac magnetic resonance.
Results:
Overall, 158 patients underwent ECG during early (4±0.4) and follow-up (29±5 days) post-AMI time points. Selvester QRS-score and Q wave area increased stepwise with LV infarct size (P<0.001). Whereas both methods manifested marked increases at a threshold of 10% LV infarction, magnitude was greater for Q wave area (>2.5-fold) than Selvester QRS-score (
Conclusion:
Q wave area provides an index for stratification of LV infarct size that performs similarly to conventional ECG assessment via the Selvester QRS-score for exclusion of large infarction.
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