title: Site of transmural late gadolinium enhancement on the cardiac MRI coincides with the ECG leads exhibiting terminal QRS distortion in patients with ST-elevation myocardial infarctions.
abstract: Large infarcts are associated with a terminal QRS-distortion in ST-elevation myocardial infarction (STEMI) patients. Late gadolinium enhancement (LGE) on the cardiac MRI (CMR) can depict an infarct distribution. However, less is known about the relationship between the LGE findings and QRS-distortion on admission, including the best ECG-lead location to reveal the QRS-distortion (DIS-lead) in STEMI patients. Fifty STEMI patients successfully treated with percutaneous coronary intervention were classified into two groups according to whether the QRS-distortion was positive (+) or negative (-). The LGE on a recent CMR was classified into 12 left ventricular segments (Basal-Middle-Apical × Anterior-Septal-Inferior-Lateral). The coincidences between the segmental LGE scores and DIS-lead were investigated. All patients were divided into 23 QRS-distortion (+) and 27 QRS-distortion (-) groups. The total LGE score was significantly greater in the QRS-distortion (+) group (14.7 ± 6.8 versus 9.6 ± 6.2, P < 0.01). The highest LGE score in 96% of QRS-distortion (+) patients was 4, and a score 4 segment indicated a good selection of the DIS-lead (86.4%). QRS-distortion in the ECG on admission represents severe transmural infarction in the LGE using CMR, which represents large infarcts in STEMI patients.
authors.affiliation: Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, Hokkaido, Japan.
authors.forename: Asami
authors.initials: A
authors.lastname: Nimura
authors.forename: Naka
authors.initials: N
authors.lastname: Sakamoto
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakagawa
authors.forename: Hisanobu
authors.initials: H
authors.lastname: Ota
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Tanabe
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Takeuchi
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Natori
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Sato
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Hasebe
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kawamura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D004562:Electrocardiography; D005260:Female; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; D005682:Gadolinium