title: Inferior Q waves in apparently healthy subjects: Should we take a deep breath? An electrocardiographic, echocardiographic and cardiac magnetic resonance study.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of electrocardiographic inferior Q waves persistence during inspiration and echocardiographic segmental wall motion abnormalities for the detection of previously unsuspected silent myocardial infarction, by using cardiac magnetic resonance as the gold standard.
  
  
  METHODS
  We prospectively enrolled 50 apparently healthy subjects with inferior Q waves on routine electrocardiogram and high atherosclerotic risk profile. Patients underwent electrocardiogram during deep inspiration, standard transthoracic echocardiography, and cardiac magnetic resonance.
  
  
  RESULTS
  Inferior Q waves during deep inspiration persisted in 10 subjects (20%) and cardiac magnetic resonance was positive in 10 (20%). Between the 10 positive cardiac magnetic resonance subjects 8 showed persistence of inferior Q waves, giving a sensitivity of 80% (95%;CI 44.4-97.5%) and a specificity of 95% (95%;CI 83.1-99.4%). Segmental wall motion abnormalities were present overall in 10 subjects (20%), but only in 5 of the 10 positive cardiac magnetic resonance subjects, giving a sensitivity of 87.5% (95% CI 73.2-95.8) and specificity of 50% (95% CI 18.7-81.3).
  
  
  CONCLUSIONS
  Electrocardiographic inferior Q waves persistence during deep inspiration is a simple test with a high accuracy for diagnosis of silent myocardial infarction. Standard echocardiography resulted less accurate.
authors.affiliation: Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Via G. Massarenti 9, 40138, Bologna, Italy. Electronic address: samuele.nanni@aosp.bo.it.
authors.forename: Samuele
authors.initials: S
authors.lastname: Nanni
authors.affiliation: Istituto di Radiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Via G. Massarenti 9, 40138, Bologna, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Lovato
authors.affiliation: Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Via G. Massarenti 9, 40138, Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Vagnarelli
authors.affiliation: Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Via G. Massarenti 9, 40138, Bologna, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Ghetti
authors.affiliation: Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Via G. Massarenti 9, 40138, Bologna, Italy.
authors.forename: Marinella
authors.initials: M
authors.lastname: Ferlito
authors.affiliation: Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Via G. Massarenti 9, 40138, Bologna, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Pasquale
authors.affiliation: Istituto di Radiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Via G. Massarenti 9, 40138, Bologna, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Russo
authors.affiliation: Istituto di Radiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Via G. Massarenti 9, 40138, Bologna, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zompatori
authors.affiliation: Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Via G. Massarenti 9, 40138, Bologna, Italy.
authors.forename: Letizia
authors.initials: L
authors.lastname: Bacchi Reggiani
authors.affiliation: Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Via G. Massarenti 9, 40138, Bologna, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Semprini
authors.affiliation: Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Via G. Massarenti 9, 40138, Bologna, Italy.
authors.forename: Nevio
authors.initials: N
authors.lastname: Taglieri
authors.affiliation: Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Via G. Massarenti 9, 40138, Bologna, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Melandri
authors.affiliation: Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Via G. Massarenti 9, 40138, Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Rapezzi
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D062485:Breath Holding; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis*; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Cardiac magnetic resonance; Echocardiography; Electrocardiography; Inferior Q waves; Silent myocardial infarction