title: Concordance of electrocardiographic patterns and healed myocardial infarction location detected by cardiovascular magnetic resonance.
abstract: Q-wave myocardial infarction (MI) location is generally based on a pathologic correlation first proposed >50 years ago. Despite the proved reliability of contrast-enhanced cardiovascular magnetic resonance (CE-CMR) imaging to detect and locate infarcted areas, no global study has been conducted with the aim of correlating the electrocardiographic (ECG) patterns of Q-wave MI with infarct location. We studied this correlation in 51 patients with ST-elevation acute coronary syndrome who presented with Q waves or equivalents during MI. Seven preestablished ECG patterns that matched with high specificity to 7 different MI locations as detected by CE-CMR imaging were used to assess its value in clinical practice to locate an infarcted area. There were 4 ECG patterns in the anteroseptal zone (23 patients; septal, apical, and/or anteroseptal, extensive anterior, and limited anterolateral) and 3 ECG patterns in the inferolateral zone (28 patients; lateral, inferior, and inferolateral). In conclusion, (1) the predefined ECG patterns we used matched well (86% global concordance) with their corresponding infarction areas as detected by CE-CMR imaging and have real value in clinical practice, and (2) the RS morphology in lead V(1) is due to lateral MI and the QS morphology in lead aVL is due to mid-anterior and mid-lateral MI. Therefore, the terms posterior and high lateral infarction are incorrect and should be changed to lateral wall and limited anterolateral wall MI.
authors.affiliation: Institute of Cardiology, Institut Catalá de Ciencias Cardiovasculares, Service of Cardiology Hospital Sant Pau, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bayés de Luna
authors.forename: Juan M
authors.initials: JM
authors.lastname: Cino
authors.forename: Sandra
authors.initials: S
authors.lastname: Pujadas
authors.forename: Iwona
authors.initials: I
authors.lastname: Cygankiewicz
authors.forename: Francesc
authors.initials: F
authors.lastname: Carreras
authors.forename: Xavier
authors.initials: X
authors.lastname: Garcia-Moll
authors.forename: Mariana
authors.initials: M
authors.lastname: Noguero
authors.forename: Miquel
authors.initials: M
authors.lastname: Fiol
authors.forename: Roberto
authors.initials: R
authors.lastname: Elosua
authors.forename: Juan
authors.initials: J
authors.lastname: Cinca
authors.forename: Guillem
authors.initials: G
authors.lastname: Pons-Lladó
mesh_terms: D004562:Electrocardiography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology