Detection and Location of Myocardial Infarction Using Electrocardiogram: Validation by Cardiovascular Magnetic Resonance Imaging.

Arquivos brasileiros de cardiologia Pub Date : 2025-05-12 eCollection Date: 2025-01-01 DOI:10.36660/abc.20240309

Maria Catarina de Melo Dias Guerra, André Gustavo da Silva Rezende, Tiago Augusto Magalhães, William Azem Chalela, Augusto Hiroshi Uchida, Rafael Almeida Fonseca, Nevelton Heringer Filho, Jürgen Beuther, Guilherme Garcia, Eduardo Cavalcanti Lapa Dos Santos, Ulisses Ramos Montarroyos, Renata Ávila Cintra, José Antônio Franchine Ramires, Carlos Eduardo Rochitte

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Abstract

Background: In the assessment of ischemic heart disease, cardiac magnetic resonance (CMR) is considered the gold standard for detecting and locating myocardial infarction (MI), but electrocardiogram (ECG) is less expensive and more widely available. Recognition of MI on ECG outside the acute phase is challenging; Q waves are absent in a significant proportion of patients and may reduce or disappear over time. Although ECG is widely used in the initial assessment of previous infarction, studies to validate ECG using CMR as a reference in the context of chronic coronary disease are limited.

Objectives: To evaluate the diagnostic performance of ECG in detecting and locating CMR-defined MI.

Methods: This study included 352 individuals who underwent CMR and ECG, 241 patients with previous MI confirmed by CMR and 111 controls with normal CMR. Their ECG tracings were analyzed by 2 observers, who were blinded to the CMR, for detection and location of MI following to the Fourth Brazilian Society of Cardiology Guidelines on the Analysis and Issuance of Electrocardiographic Reports. The significance level adopted was 5% (p < 0.05).

Results: ECG showed good performance for detecting previous MI, with sensitivity of 69.3% (64.5% to 74.1%), specificity of 99.1% (98.1% to 100%), and accuracy of 78.7% (74.4% to 83.0%). However, in locating MI in accordance with CMR, its accuracy was unsatisfactory.

Conclusions: When compared to CMR, ECG was shown to be a method with good accuracy for detecting previous MI, but not for defining its location.

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用心电图检测和定位心肌梗死：心血管磁共振成像的验证。

背景：在缺血性心脏病的评估中，心脏磁共振（CMR）被认为是检测和定位心肌梗死（MI）的金标准，但心电图（ECG）更便宜，应用更广泛。急性期以外心电图对心肌梗死的识别具有挑战性；Q波在很大比例的患者中不存在，随着时间的推移可能减少或消失。虽然心电图被广泛用于对既往梗死的初步评估，但在慢性冠状动脉疾病的背景下，将CMR作为参考来验证心电图的研究是有限的。目的：评价心电图在CMR诊断心肌梗死中的诊断作用。方法：本研究纳入352例行CMR和ECG检查的患者，241例CMR确诊的心肌梗死患者和111例CMR正常的对照组。根据第四届巴西心脏病学会关于分析和发布心电图报告的指南，由2名对CMR不知情的观察者分析他们的心电图，以检测和定位心肌梗死。采用显著性水平为5% （p < 0.05）。结果：心电图对既往心肌梗死的检测效果较好，灵敏度69.3%(64.5% ~ 74.1%)，特异性99.1%(98.1% ~ 100%)，准确率78.7%（74.4% ~ 83.0%）。然而，在根据CMR定位MI时，其准确性并不令人满意。结论：与CMR相比，ECG被证明是一种检测先前心肌梗死的准确方法，但不能确定其位置。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Arquivos brasileiros de cardiologia

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