Evaluation of a QRS scoring system for estimating myocardial infarct size. VI: Identification of screening criteria for non-acute myocardial infarcts

Anderson, William D.; Wagner, Nancy B.; Lee, Kerry L.; White, Richard D.; Yuschak, James V.; Behar, Victor S.; Selvester, Ronald H.; Ideker, Raymond E.; Wagner, Galen S.

doi:10.1016/0002-9149(88)91056-9

Cited by 75 publications

(17 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…13 The 3 major infarct regions (anterior, lateral, and inferior) were defined in this study according to the location of the Q waves; an anterior MI was defined by the presence of pathological Q waves in 2 precordial leads (V 1 to V 5 ) or any Q wave in lead V 2 . A lateral MI was defined by the presence of pathological Q waves in at least 2 of 3 lateral leads (I, aVL, or V 6 ).…”

Section: Ecg Criteria For Pathological Q Wavesmentioning

confidence: 99%

Significance of a Fragmented QRS Complex Versus a Q Wave in Patients With Coronary Artery Disease

et al. 2006

View full text Add to dashboard Cite

Background-Q waves on a 12-lead ECG are markers of a prior myocardial infarction (MI). However, they may regress or even disappear over time, and there is no specific ECG sign of a non-Q-wave MI. Fragmented QRS complexes (fQRSs), which include various RSRЈ patterns, without a typical bundle-branch block are markers of altered ventricular depolarization owing to a prior myocardial scar. We postulated that the presence of an fQRS might improve the ability to detect a prior MI compared with Q waves alone by ECG. Methods and Results-A cohort of 479 consecutive patients (meanϮSD age, 58.2Ϯ13.2 years; 283 males) who were referred for nuclear stress tests was studied. The fQRS included various morphologies of the QRS (Ͻ120 ms), which included an additional R wave (RЈ) or notching in the nadir of the S wave, or Ͼ1 RЈ (fragmentation) in 2 contiguous leads, corresponding to a major coronary artery territory. The Q wave was present in 71 (14.8%) patients, an fQRS was present in 191 (34.9%) patients, and an fQRS and/or a Q wave was present in 203 (42.3%) patients. Sensitivity, specificity, and the negative predictive value for myocardial scar as detected by single photon emission computed tomography analysis were 36.3%, 99.2%, and 70.8%, respectively, for the Q wave alone; 85.6%, 89%, and 92.7%, respectively, for the fQRS; and 91.4%, 89%, and 94.2%, respectively, for the Q wave and/or fQRS. Conclusions-The fQRS on a 12-lead ECG is a marker of a prior MI, defined by regional perfusion abnormalities, which has a substantially higher sensitivity and negative predictive value compared with the Q wave.

show abstract

Section: Ecg Criteria For Pathological Q Wavesmentioning

confidence: 99%

Significance of a Fragmented QRS Complex Versus a Q Wave in Patients With Coronary Artery Disease

et al. 2006

View full text Add to dashboard Cite

show abstract

“…The determination of the Q wave or Q-wave equivalent was completed at baseline using the Selvester QRS screening criteria. 9 A pathologic Q wave was defined as follows: ≥ 30 ms in lead aVF (inferior), ≥ 40 ms in leads I and aVL (lateral), ≥ 40 ms in two or more of leads V4, V5 or V6 (apical), or any Q wave ≥ 20 ms or QS complex in leads V2 and V3 (anterior). Q-wave equivalents were defined as follows: R wave ≥ 40 ms in V1 (posterior) or R wave ≤ 0.1 mV and ≤ 10 ms in V2 (anterior).…”

Section: Electrocardiogram Analysismentioning

confidence: 99%

Baseline Q waves as a prognostic modulator in patients with ST-segment elevation: insights from the PLATO trial

Siha

Das

et al. 2012

CMAJ

View full text Add to dashboard Cite

T he clinical outcome of patients with STsegment elevation myocardial infarction (STEMI) is directly related to the extent of myocardial necrosis.1 Because the extent of necrosis is strongly influenced by the duration of symptoms, time is a key clinical proxy for the stage of evolution of STEMI.2 The length of time from the onset of symptoms is important in strategies for triage and management and for gauging prognosis. Although time from the occurrence of epicardial artery occlusion in a laboratory experimental model can be measured precisely, time from the onset of symptoms is often difficult to accurately estimate because of subjectivity and reliance on recall. Thus, establishing a more reliable method for determining the stage of myocardial infarction (MI) evolution in patients with STEMI would be useful for evaluating the potential for myocardial salvage and guiding clinical management.There is evidence that the assessment of Q waves on the baseline electrocardiogram (ECG) in the region of ST-segment elevation may be a useful predictor of left ventricular dysfunction and outcomes in patients with STEMI given streptokinase within four to six hours of the onset of symptoms. 3,4 Because prior studies of the predictive value of baseline Q waves focused on patients receiving fibrinolytic therapy, we extended this question to a large population of patients with STEMI who were at high risk of adverse clinical outcomes (e.g., death,

show abstract

“…Fragmentation of the QRS complex has been explained by inhomogeneous activation of the myocardium due to myocardial scar or ischemia (12). Infarct size is inversely related with collateral circulation and directly related with the occlusion time (13).…”

Section: Discussionmentioning

confidence: 99%

Relation between fragmented QRS and collateral circulation in patients with chronic total occlusion without prior myocardial infarction

Kadı¹,

Ceyhan²,

Koç³

et al. 2011

Anadolu Kardiyol Derg

View full text Add to dashboard Cite

ÖZETAmaç: Yapılan çalışmalarda, elektrokardiyogramdaki (EKG) fragmente QRS'in (fQRS) Q dalgasız miyokart enfarktüslü (Mİ) hastalarda bölgesel miyokardiyal skarı gösterdiği bildirilmiştir. Koroner arter hastalığı olan hastalarda, koroner kollateral dolaşımın enfarktüs veya iskemiyi önleye-bileceği birçok çalışmada gösterilmiştir. Biz bu çalışmada; EKG'deki fQRS varlığının, daha önce Mİ geçirmemiş kronik total oklüzyonlu hastalarda kollateral gelişim ile ilişkisini göstermeyi amaçladık. Yöntemler: Geriye dönük gözlemsel çalışmamızda, çalışma grubumuz; bir majör koroner arteri tam tıkalı olan 56 hastadan oluşmaktadır (ortalama yaş 61.73±7.96 yıl; %67 erkek). Kollateral dolaşım derecelendirilmesi Rentrop sınıflamasına göre yapıldı. Fragmente QRS; majör koroner arter bölgesine uyan, birbirine bitişik en az iki derivasyonda ikinci bir R dalgasının (R') varlığı, R ya da S dalgasının çentikleşmesi ya da R dalgasının fragmentasyonu (birden fazla R') olarak tarif edildi. Miyokart enfarktüsü hikayesi, EKG'de patolojik Q dalgası veya tipik dal bloğu ya da inkomplet sağ dal bloğu olan hastalar çalışmadan dışlandı. İstatistiksel analiz Ki-kare testi, Student t-testi ve lojistik regresyon analiz ile yapıldı. Bulgular: Çalışma grubundaki 56 hastanın 22'si (%39) EKG'de fQRS'e sahipti. Hastaların 15'i (%27) Rentrop 1, 15'i (%27) Rentrop 2 ve 26'sı (%46) Rentrop 3 kollateral dolaşıma sahipti. Rentrop 3 kollateral dolaşıma sahip hastaların 5'i (%19), Rentrop 2 kollateral dolaşıma sahip olanların 7'si (%47), Rentrop 1 kollateral akıma sahip olanların 10'u (%67) EKG'de fQRS'e sahipti (p=0.002). Lojistik regresyon analizlerinde Rentrop 1 kollateral dolaşım için fQRS'in prediktif değeri yüksek bulundu (OR=8.4, %95 GA 1.97-35.7, p=0.004). ABSTRACTObjective: It has been shown that the fragmented QRS (fQRS) on electrocardiogram (ECG) signifies regional myocardial scar in patients with non-Q-wave myocardial infarction (MI). We hypothesized that presence of fQRS on ECG may be related with poorly-grown collateral coronary circulation (CCC) in patients with chronic total coronary occlusion (CTO) without prior MI. Methods: This retrospective observational study is included 56 patients (mean age 61.73±7.96 years; 67.9% men) with CTO in one of the major coronary arteries. Collateral circulation was graded according to Rentrop's classification. The fQRS was defined as the presence of an additional R wave or notching of R or S wave or the presence of fragmentation in two contiguous ECG leads corresponding to a major coronary artery territory. Patients with pathological Q-wave or history of MI, typical bundle brunch blocks (BBB) and incomplete right BBB were excluded from study. Statistical analysis was performed using Chi-square test, Student's t-test and logistic regression analysis. Results: Fifteen patients had Rentrop grade 1, 15 patients had grade 2 and 26 patients had grade 3 CCC. Five (19%) of the patients who have grade 3 CCC, seven (47%) of the patients who had grade 2 CCC, ten (67%) of the patients who had grade 1 CCC had fQRS (p=0.002)....

show abstract

Evaluation of a QRS scoring system for estimating myocardial infarct size. VI: Identification of screening criteria for non-acute myocardial infarcts

Cited by 75 publications

References 9 publications

Significance of a Fragmented QRS Complex Versus a Q Wave in Patients With Coronary Artery Disease

Significance of a Fragmented QRS Complex Versus a Q Wave in Patients With Coronary Artery Disease

Baseline Q waves as a prognostic modulator in patients with ST-segment elevation: insights from the PLATO trial

Relation between fragmented QRS and collateral circulation in patients with chronic total occlusion without prior myocardial infarction

Contact Info

Product

Resources

About