Engblom Henrik, Carlsson Minna B, Hedström Erik, Heiberg Einar, Ugander Martin, Wagner Galen S, Arheden Håkan
Department of Clinical Physiology, Lund University Hospital, Lund, Sweden.
Clin Physiol Funct Imaging. 2007 Mar;27(2):101-8. doi: 10.1111/j.1475-097X.2007.00723.x.
Historically, Q-wave myocardial infarction (MI) has been equated with transmural MI. This association have, however, recently been rejected. The endocardial extent of MI is another potential determinant of pathological Q waves, since the first part of the QRS complex where the Q wave appears reflects depolarization of subendocardial myocardium. Therefore, the aim of the present study was to test the hypothesis that endocardial extent of MI is more predictive of pathological Q waves than is MI transmurality and to investigate the relationship between QRS scoring of the ECG and MI characteristics.
Twenty-nine patients with reperfused first-time MI were prospectively enrolled. One week after admission, delayed contrast-enhanced magnetic resonance imaging (DE-MRI) was performed and 12-lead ECG was recorded. Size, transmurality and endocardial extent of MI were assessed by DE-MRI. Q waves were identified with Minnesota coding and electrocardiographic MI size was estimated by QRS scoring of the ECG.
There was a significant difference between patients with and without Q waves with regard to MI size (P = 0.03) and endocardial extent of MI (P = 0.01), but not to mean and maximum MI transmurality (P = 0.09 and P = 0.14). Endocardial extent was the only independent predictor of pathological Q waves. Endocardial extent of MI was most strongly correlated to QRS score (r = 0.86, P<0.001) of the MI variables tested.
The endocardial extent of reperfused first-time acute MI is more predictive of pathological Q waves than is MI transmurality.
从历史上看，Q波心肌梗死（MI）一直被等同于透壁性MI。然而，这种关联最近已被否定。MI的心内膜范围是病理性Q波的另一个潜在决定因素，因为Q波出现的QRS波群的第一部分反映了心内膜下心肌的去极化。因此，本研究的目的是检验以下假设：MI的心内膜范围比MI的透壁程度更能预测病理性Q波，并研究心电图的QRS评分与MI特征之间的关系。
前瞻性纳入29例首次再灌注MI患者。入院1周后，进行延迟对比增强磁共振成像（DE-MRI）并记录12导联心电图。通过DE-MRI评估MI的大小、透壁程度和心内膜范围。用明尼苏达编码识别Q波，并通过心电图的QRS评分估计心电图MI大小。
有Q波和无Q波的患者在MI大小（P = 0.03）和MI的心内膜范围（P = 0.01）方面存在显著差异，但在平均和最大MI透壁程度方面无显著差异（P = 0.09和P = 0.14）。心内膜范围是病理性Q波的唯一独立预测因素。MI的心内膜范围与所测试的MI变量的QRS评分相关性最强（r = 0.86，P<0.001）。
首次再灌注急性MI的心内膜范围比MI的透壁程度更能预测病理性Q波。
