Diagnostic value of the electrocardiogram in the assessment of prior myocardial infarction

Abstract

Background The best available imaging technique for the detection of prior myocardial infarction (MI) is cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE). Although the electrocardiogram (ECG) still plays a major role in the diagnosis of prior MI, the diagnostic value of the ECG remains uncertain. This study evaluates the diagnostic value of the ECG in the assessment of prior MI. Methods In this retrospective study, data from electronic patient files were collected of 1033 patients who had undergone CMR with LGE between January 2014 and December 2017. After the exclusion of 59 patients, the data of 974 patients were analysed. Twelve-lead ECGs were blinded and evaluated for signs of prior MI by two cardiologists separately. Disagreement in interpretation was resolved by the judgement of a third cardiologist. Outcomes of CMR with LGE were used as the gold standard. Results The sensitivity of the ECG in the detection of MI was 38.0% with a 95% confidence interval (CI) of 31.6–44.8%. The specificity was 86.9% (95% CI 84.4–89.1%). The positive and negative predictive value were 43.6% (95% CI 36.4–50.9%) and 84.0% (95% CI 81.4–86.5%) respectively. In 170 ECGs (17.5%), the two cardiologists disagreed on the presence or absence of MI. Inter-rater variability was moderate (κ 0.51, 95% CI 0.45–0.58, p < 0.001). Conclusion The ECG has a low diagnostic value in the detection of prior MI. However, if the ECG shows no signs of prior MI, the absence of MI is likely. This study confirms that a history of MI should not be based solely on an ECG.

Magnetic Resonance Texture Analysis in Myocardial Infarction

“…Cardiac magnetic resonance (CMR) has advantages, such as non-Radiative, multiparameters and sequences, multiplanar reconstruction capabilities, and high tissue resolution, which composes the "gold standard" tool for evaluating the cardiac structure and function non-invasively and becomes the best available imaging technique for detection of MI (7,8). Meanwhile, CMR has essential significance in stratifying risk, predicting prognosis, predicting response to therapy, detecting complications, etc., in MI (8). Nevertheless, the traditional visual inspection of images may not recognize subtle differences and detect invisible signal changes (9,10).…”

‘I tested positive, so do I have the condition or not?’

“…In this issue of the Netherlands Heart Journal , Lobeek et al. describe an analysis that may be—partly—of help to our patient and is therefore highly relevant [ 1 ]. The authors assessed the value of ECG to detect a prior myocardial infarction (MI) by retrospectively studying over a 1000 patients who had undergone cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) and for whom a recent ECG was available.…”