7 Diagnostic accuracy of 12 lead ECG Q-waves as a marker of myocardial scar: validation with CMR: Abstract 7 Table 1

Abstract

Background Myocardial extracellular volume (ECV) can be estimated by cardiac magnetic resonance imaging (CMR) using preand post-contrast T1 MOLLI maps. The age and sex associations with myocardial ECV in healthy mid-life adults are uncertain. Methods Healthy adults without any history of cardiovascular disease or treatment underwent contrast-enhanced CMR at 1.5 Tesla (Siemens MAGNETOM Avanto). T1 mapping with MOLLI was performed before and 15 min after contrast (0.15 mmol/kg gadoterate meglumine). ECV was estimated in regions (AHA 16-segment LV model) and for the whole left ventricular (LV) myocardium (all regions). ECV was calculated as the difference in relaxation rate (R1=1/T1) for myocardium and LV blood pool before vs. after gadolinium contrast administration, corrected for haematocrit (HCT). LV segments which were not evaluable due to artefact were excluded from analysis. Results 114 segments were assessed from 19 subjects (mean age 61 ± 12 years; 10 (53%) male). 21 (18%) segments were excluded due to blood pool artefact or signal drop-out in the pre-contrast T1 MOLLI scan. All segments were evaluable in the post-contrast T1 MOLLI scans. The remaining segments for each subject were averaged to give an overall ECV (global LV). The mean ECV for all subjects was 25.6 ± 2.9%. There was no overall segmental variation in ECV. ECV in females was higher than in males (27.6 ± 3.1% vs. 23.9 ± 1.3%; P = 0.003) The percentage difference was 14.5%. ECV was higher in septal segments in females (anteroseptal: 28.0 ± 3.3% vs. 24.2 ± 1.5%; P = 0.004; inferoseptal: 27.3 ± 3.8% vs. 23.5 ± 1.6%; P = 0.011), whereas no differences were observed for other segments (Table 1). Conclusion In this preliminary analysis, myocardial ECV was higher in women than in men, which was attributable to higher ECV in the septum in females. This sex difference merits further study. If these results are confirmed by other studies, then sex-specific reference ranges for ECV would seem appropriate. Background Traditionally, the presence of Q-waves on 12 lead ECG is considered a marker of a large and/or transmural myocardial infarction (MI). Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) accurately identifies the presence and extent of myocardial infarction and has become the gold standard for the assessment of myocardial viability. Aim To determine the diagnostic accuracy of Q-waves on 12 lead ECG to identify myocardial scarring as compared with CMR. Methods Data was collected on 631 consecutive patients referred for a stress CMR with suspected ischaemic heart disease (April 2013 to Mar 2014). A 12-lead ECG was recorded. Pathological Q-waves -deflection amplitude of >25% of the subsequent R wave, or being >0.04 s (40 ms) in width and >2 mm in amplitude in >1 corresponding lead. A comprehensive CMR protocol was used. Transmural infarction was defined as >50% LGE. DIAGNOSTIC ACCURACY OF 12 LEAD ECG Q-WAVES AS A MARKER OF MYOCARDIAL SCAR: VALIDATION WITH CMRResults 498 patients were included (mean age of 64 ± 12 years, 71% ...

Detecting myocardial scar using electrocardiogram data and deep neural networks

“…Comparison to existing approaches Table 2 relates the performance of our models to that of applying the Selvester score (Selvester et al 1971;Selvester et al 1985), human-based ECG evaluation, and two SVM-based approaches. The measures of both our models deliver comparably high performance measures and reach (ECG-based model) or exceed human performance (combined model) as published by Asch et al (2006), Carpenter et al (2015), and Markendorf et al (2019).…”