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The pathologic basis of Q-wave and non–Q-wave myocardial infarction

A cardiovascular magnetic resonance study

James C. C. Moon, MB, BCh^*, Diego Perez De Arenaza, MD, Andrew G. Elkington, MB, BCh^*, Anil K. Taneja, MD, Anna S. John, MD^*, Duolao Wang, PhD, Rajesh Janardhanan, MD, Roxy Senior, MD, DM, FACC, Avijit Lahiri, MBBS, MSc, FACC, Philip A. Poole-Wilson, MD, FACC^|| and Dudley J. Pennell, MD, FACC^*,*

^* Centre for Advanced Magnetic Resonance in Cardiology (CAMRIC), London, United Kingdom
Clinical Trials Evaluation Unit, Royal Brompton Hospital, London, United Kingdom
Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
Department of Cardiology, Northwick Park Hospital, London, United Kingdom
^|| National Heart and Lung Institute, Imperial College, London, United Kingdom

View larger version (136K): [in a new window]   Figure 1 A representative complete late gadolinium enhancement study. This patient had a first anterior myocardial infarction (MI) four months previously owing to an occluded left anterior descending coronary artery. The MI was quantified as 42% of the total myocardium (71% of anterior territory, 36% of inferior, and 8% of lateral). The MI was transmural in four of the seven segments in the anterior territory. LA = left atrium; LV = left ventricle; RV = right ventricle; SA = short axis.

View larger version (32K): [in a new window]   Figure 2 Polar plot of the 17 myocardial segments and their classification into territories with associated electrocardiographic lead changes. RBBB = right bundle-branch block.

View larger version (26K): [in a new window]   Figure 3 The probability of classification as Q-wave (QW) myocardial infarction (MI) by Thrombolysis In Myocardial Infarction (TIMI) criteria plotted against the quintiles of transmural extent (left graph), or total MI size (right graph). As both the transmural extent and the total size of MI increases, so the likelihood of classification as QW MI increases, for anterior and inferior but not lateral territories. Gray bars = lateral; cross-hatched bars = anterior; white bars = inferior.

View larger version (23K): [in a new window]   Figure 4 Receiver operating characteristic (ROC) curve analysis of infarct size as a predictor of the presence of Q waves (Thrombolysis In Myocardial Infarction [TIMI] criteria) for anterior (solid line) and inferior (dashed line) territories.

View larger version (162K): [in a new window]   Figure 5 Three anterior MIs with contrast images and electrocardiographic leads V1 to V6 shown: (A) non-transmural Q-wave (QW) myocardial infarction (MI), (B) transmural non–Q-wave (NQW) MI, (C) transmural NQW MI with right bundle-branch block. These cases illustrate the relative importance of the total size of infarction over the transmural extent of infarction. The non-transmural MI shows QWs, with 24% of the left ventricle (LV) infarcted, whereas the transmural MIs do not have QWs, with 9% and 13% of the LV infarcted, respectively. The infarct localized to the septum (C), but still defined as an anterior territory MI has associated right bundle-branch block rather than QWs. RV = right ventricle.