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Assessing myocardial viability: correlation of myocardial wall motion abnormalities and pathologic Q waves with
J I Haft1, A J Hammoudeh, P J Conte
1Department of Medicine, Saint Michael's Medical Center, Newark, NJ 07102, USA.
Insights
Predicting myocardial viability for coronary revascularization is complex. Electrocardiogram (ECG) and left ventriculography findings show significant, but not definitive, correlation with stress sestamibi scans, highlighting the need for combined assessments.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Diagnostic Imaging
Background:
- Clinical benefit of coronary revascularization hinges on myocardial viability.
- Accurate assessment of myocardial viability is crucial for treatment decisions.
Purpose of the Study:
- To evaluate if electrocardiogram (ECG) and left ventriculography can predict myocardial viability.
- To correlate ECG findings (pathologic Q waves) and left ventricular wall motion abnormalities with stress sestamibi scan results.
Main Methods:
- Correlative study involving 201 patients undergoing coronary revascularization assessment.
- Comparison of ECG, contrast left ventriculography, and stress sestamibi scanning findings.
- Analysis of Q waves, wall motion abnormalities, and sestamibi defect patterns (fixed vs. reversible).
Main Results:
- Significant correlations were observed between Q waves, wall motion abnormalities, and sestamibi uptake.
- However, 53.8% of discordant findings were noted, such as normal wall motion with fixed sestamibi defects.
- Abnormal wall motion was present in 46.1% of regions with fixed sestamibi defects.
Conclusions:
- ECG and left ventriculography findings alone are insufficient to definitively predict myocardial viability.
- Discordant results necessitate a comprehensive assessment combining contractile function (wall motion) and metabolic activity (sestamibi scan).
- Nonviability should not be assumed without evaluating both parameters.
Abstract:
The clinical benefit of coronary revascularization depends largely on the viability of the myocardium that is perfused. To determine if the combination of electrocardiogram and left ventriculography findings could be used to predict viability, the presence of pathologic Q waves and wall motion abnormalities on contrast left ventriculography were correlated with findings on stress sestamibi scanning in 201 patients. Wall motion was abnormal in 51.5% of 103 Q regions; 30 (56.6%) of these had fixed sestamibi defects, and 22.6% had fully or partially reversible sestamibi defects. Q waves were associated with 43.4% of 122 regions with wall motion abnormality; 67.9% of these areas had fixed or partially fixed sestamibi defects. Wall motion abnormalities were present in 46.1% of 104 areas with fixed sestamibi defects. Although there was a statistically significant correlation among Q waves, left ventricular wall motion abnormalities, and stress sestamibi uptake (and various combinations of these data), the relatively large number (53.8%) of discordant findings (e.g., normal ventricular wall motion in the presence of fixed sestamibi defects) suggests that nonviability cannot be assumed without at least assessing both contractile left ventricular motion and metabolic (e.g., sestamibi scanning) function.