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Published on: May 29, 2010
Influence of left ventricular cavity dimension on electrocardiographic estimation of the extent of wall motion
Insights
Left ventricular cavity dimension significantly impacts electrocardiogram (ECG) estimations of myocardial infarction (MI) wall motion abnormalities. ECG signs of necrosis are poorly related to actual asynergy extent, especially with left ventricular dilatation.
Area of Science:
- Cardiology
- Medical Imaging
- Electrocardiography
Background:
- Assessing myocardial infarction (MI) extent post-event is crucial.
- Electrocardiography (ECG) and echocardiography are key diagnostic tools.
- Left ventricular (LV) dimensions may influence ECG interpretations.
Purpose of the Study:
- To evaluate how left ventricular cavity size affects ECG-based estimation of wall motion abnormalities after acute MI.
- To determine the correlation between ECG findings and echocardiographic measures of asynergy in relation to LV dimensions.
Main Methods:
- Two-dimensional echocardiograms and standard 12-lead ECGs were performed on 221 patients within 3 months post-MI.
- Patients were categorized based on MI location (anterior, inferior, anteroinferior) and LV size (dilated vs. normal).
- Asynergy extent (echo index) and ECG signs of necrosis (Q waves, Wagner's score) were quantified and correlated.
Main Results:
- In anterior MI, both asynergy and ECG necrosis signs were greater in patients with LV dilatation. Strong ECG-asynergy correlation existed in normal LV size but not in dilated LV.
- In inferior MI, asynergy was more extensive with LV dilatation, but ECG necrosis extent was similar, with no significant ECG-asynergy correlation.
- Anteroinferior MI showed insignificant ECG-asynergy correlations regardless of LV size.
Conclusions:
- Electrocardiographic patterns of necrosis are poorly related to the actual extent of myocardial asynergy.
- Left ventricular dimensions significantly influence the electrocardiographic estimation of MI severity and wall motion abnormalities.
Abstract:
To estimate the influence of left ventricular cavity dimension on the electrocardiographic estimation of the extent of wall motion abnormalities, two-dimensional echocardiograms and standard 12-lead electrocardiograms (ECG) were carried out on 221 patients within 3 months after acute myocardial infarction (MI). Among the patients with anterior MI (96 patients; 43.4%) both the extent of asynergy (% of asynergic segments, an echo index taking into account the type of asynergy) and the electrocardiographic signs of necrosis (number of Q waves greater than or equal to 40 ms, Wagner's score) were significantly greater (p less than 0.001) in those with left ventricular dilatation (60 patients) than in those with normal ventricular size (36 patients); within the latter group, the ECG-asynergy correlations were good (r value 0.67-0.79). In patients with left ventricular dilatation no correlation was found. In inferior MI (108 patients, 48.9%), asynergy was more extensive in patients with left ventricular dilatation (p less than 0.001) than in those with normal left ventricle. However, the electrocardiographic extent of necrosis was similar in the two groups and no significant ECG-asynergy correlation was found. Likewise, in anteroinferior MI (17 patients; 7.7%), the ECG-asynergy correlations were statistically insignificant in both groups. In conclusion, the electrocardiographic patterns of necrosis are poorly related to the extent of asynergy and are greatly influenced by left ventricular dimensions.
