Electrocardiographic evolution after Q-wave anterior myocardial infarction: correlations between QRS score and changes in left ventricular perfusion and function.
BACKGROUND
In the thrombolytic era, conflicting data have been reported on the usefulness of the QRS score in estimating the amount of left ventricular (LV) damage after acute myocardial infarction (MI).


RESULTS
We correlated the QRS score with the extent of LV hypoperfusion and ejection fraction (EF) in 95 consecutive male patients with a first anterior Q-wave MI; the 6-month evolution of QRS score and changes in LV perfusion and function were also compared. The Selvester-Wagner QRS score was computed from the digitized 12-lead electrocardiogram, both at predischarge and 6 months later; at the same time, resting sestamibi first-pass ventriculography and single photon emission computed tomography imaging were performed. A reduction in QRS score occurred at 6 months (6.7 +/- 3.4 vs 7.8 +/- 2.9 at predischarge; P <.001); the perfusion defect extent also decreased (P <.01), and LV EF improved (P <.05). At predischarge, no correlation was found between QRS score and hypoperfusion extent or EF; in contrast, a weak correlation was observed 6 months later (r = 0.55; P <.001; and r = 0.48; P <.01, respectively). QRS score changes from predischarge to 6 months showed limited accuracy in predicting clinically meaningful changes of perfusion or EF (receiver operating characteristic area under the curve, 0.58 and 0.61, respectively). Thrombolytic therapy did not influence the relationship between QRS score and scintigraphic findings.


CONCLUSIONS
In patients with recent anterior Q-wave MI, QRS scoring showed a weak, delayed correlation with the amount of LV damage, as estimated by radionuclide techniques. Spontaneous changes in QRS score from predischarge to 6 months seem to be of limited value in identifying patients with late improvement in LV perfusion and function.
Marcassa
C
C
Division of Cardiology, Salvatore Maugeri Foundation IRCCS, Veruno (NO), Italy. cmarcassa@fsm.it
Galli
M
M
Paino
A
A
Campini
R
R
Giubbini
R
R
Giannuzzi
P
P
D000328:Adult; D003326:Coronary Circulation; D004562:Electrocardiography; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D011446:Prospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D016277:Ventricular Function, Left