title: Diagnosis and discrimination of remote antero- and inferoseptal non-Q wave myocardial infarctions with body surface potential mapping.
abstract: BACKGROUND
  Previous studies have shown that the diagnosis and localization of previous non-Q wave myocardial infarction (NQMI) is possible by body surface potential mapping (BSPM), but the criteria for the discrimination between anteroseptal and inferoseptal middle regions remain to be determined.
  
  
  METHODS
  BSPM using 63 unipolar leads was recorded in 119 patients with previous NQMI (36 to 76 years of age, average 61 years; 85 men). Localization of anteroseptal or inferior middle NQMI occurred in 70 cases (44 to 76 years of age, average 61 years, 53 men) by determining early anterior minimum potential with only slight negativity. In these cases, isopotential maps obtained at additional time points were investigated to discriminate between anteroseptal and inferoseptal NQMI. The clinical localization was based on the concordance of two of the following tests: wall motion disturbances on echocardiography, coronary angiogram and repolarization changes in the acute-phase electrocardiogram.
  
  
  RESULTS
  Two milliseconds before the appearance of the first anterior minimum, a more accentuated superior negativity indicated anteroseptal NQMI (32 of 70 cases), while a more pronounced inferior negativity indicated inferoseptal NQMI (38 of 70 cases). Fisher's exact test showed statistically significant associations between the above BSPM localizations and the clinical localizations (P<0.001). Occlusion or stenosis of the expected infarct-related coronary artery was detected in all patients either as a single lesion or together with other coronary artery lesions.
  
  
  CONCLUSIONS
  The BSPM criteria proposed here are suitable to detect the most frequent NQMI localizations. The narrowing of the infarct-related coronary arteries, the left anterior descending or the posterior descending coronary artery, can be thus differentiated.
authors.affiliation: Central Hospital of Ministry of Interior, Cardiology, Budapest, Hungary.
authors.forename: Mihály
authors.initials: M
authors.lastname: Medvegy
authors.forename: Réginald
authors.initials: R
authors.lastname: Nadeau
authors.forename: Endre
authors.initials: E
authors.lastname: Szücs
authors.forename: Krisztina
authors.initials: K
authors.lastname: Szakolczai
authors.forename: Gábor
authors.initials: G
authors.lastname: Simonyi
authors.forename: Tamás
authors.initials: T
authors.lastname: Bauernfeind
authors.forename: Miklos
authors.initials: M
authors.lastname: Szedlák
authors.forename: Pierre
authors.initials: P
authors.lastname: Savard
authors.forename: Donald
authors.initials: D
authors.lastname: Palisaitis
authors.forename: István
authors.initials: I
authors.lastname: Préda
mesh_terms: D000328:Adult; D000368:Aged; D018780:Body Surface Potential Mapping; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity