![]() ![]() Nevertheless in recent years, these limitations have been largely overcome by the increasing use of advanced imaging techniques such as Cardiac Magnetic Resonance Late Gadolinium Enhancement which rapidly has become the gold-standard technique for in-vivo identification of myocardial scar. This is because such studies have employed necropsy or angiographic observations as standards of reference against which to assess the properties of the ECG criteria. In the past, studies about the correlation between electrocardiographic abnormalities and the presence of myocardial scar has been severely limited in literature and involved small cohorts of patients. Prior myocardial infarction is characterized by the presence of myocardial scar. In common clinical practice, we know that Q waves or QS complexes, in the absence of QRS confounders, are pathognomonic of a prior myocardial infarction in patients with chronic ischemic heart disease regardless of symptoms. Indeed, the usefulness of the electrocardiogram in clinical practice is well known, due to the fact that ECG is a very simple non-invasive technique, easily available and economic. Nowadays the Electrocardiogram represents the easiest medical instrument approach for assessing several heart clinical conditions such as ischemic heart disease. This study suggests that Q waves ESC ECG criteria may be a poor marker for detecting myocardial scar in patients with prior MI. The sensitivity and specificity of wall-specific ECG changes in presence of 2+ pathological Q-waves were 42% and 88% for anterior, 43% and 69.9% for inferior and 28.6% and 76% for lateral wall in presence of 3+ Q waves they were 24% and 95% for anterior, 27.8% and 82.5% for inferior and 9.5% and 93.8% for lateral wall. Sensitivity and specificity of wallspecific ECG changes in presence of 2+ or 3+ pathological Q waves in the corresponding wall leads have been evaluated for anterior (V1-V4 leads), inferior (D2, DIII, aVF leads) and lateral (D1, aVL, V5-V6 leads) wall in patients with transmural infarction, defined as >50% LGE. A 12-ECG lead was recorded in each patient. ![]() Data was collected on 500 patients referred for a 3 Tesla cMRI viability study. Cardiac Magnetic Resonance (cMRI) Late Gadolinium Enhancement (LGE) is considered the gold standard technique for the detection of myocardial scar. Prior MI is characterized by the presence of scar. In common clinical practice, Q waves, or QS complexes in the absence of QRS confounders are pathognomonic of prior Myocardial Infarction (MI) in patients with chronic Ischemic Heart Disease (IHD) regardless of symptoms. This study was designed to assess the sensitivity and specificity of the pathological Q waves as defined in Electrocardiogram (ECG) criteria of European Society Guidelines (ESC) in myocardial scar assessment in patients with prior myocardial infarction.
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