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Baseline ST elevation and myocardial scar: Results from the multi-ethnic study of atherosclerosis

Timothy M Markman1, David Bluemke2, Elsayed Z Soliman3

  • 1Department of Medicine, The Johns Hopkins University, Baltimore, MD, United States of America; Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States of America.

Journal of Electrocardiology
|June 28, 2019
PubMed

Insights

ST elevation on electrocardiograms (ECG) may indicate abnormal heart muscle. This study found ST elevation is associated with unrecognized myocardial scar detected by cardiac magnetic resonance imaging (CMR).

Area of Science:

  • Cardiology
  • Medical Imaging
  • Electrocardiography

Background:

  • The underlying cause of ST elevation on baseline electrocardiograms (ECG) is not fully understood.
  • Abnormal myocardial substrate is a potential contributor to ST elevation.
  • This study investigates the link between unrecognized myocardial scar on cardiac magnetic resonance imaging (CMR) and baseline ST elevation.

Purpose of the Study:

  • To determine if clinically unrecognized myocardial scar, identified via CMR, is associated with ST elevation on baseline ECG.
  • To explore the relationship between myocardial scar patterns and ST elevation in a general population.

Main Methods:

  • Utilized data from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort.
  • Included 1365 participants who underwent both ECG and contrast-enhanced CMR.
  • Employed multivariable logistic regression to analyze the association between ST elevation and CMR-defined myocardial scar, adjusting for cardiovascular risk factors.

Main Results:

  • Among 1365 participants, 105 (8%) had myocardial scar on CMR.
  • ST elevation was present in 435 participants (32%), predominantly in lateral leads.
  • ST elevation was significantly associated with scar in the basal anterior region (OR 18.2, p=0.031) after full adjustment.

Conclusions:

  • Baseline ST elevation in inferior or lateral leads is linked to myocardial scar in basal inferior and anterior segments within a community population.
  • Myocardial scar may mediate the previously observed association between ST elevation and increased mortality.
Abstract

Keywords:
Cardiac magnetic resonance imagingEarly repolarizationMyocardial scarST elevation

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