Limitations of premature ventricular complex morphology in the diagnosis of myocardial infarction |
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| Authors: | J M Wahl A H Hakki A S Iskandrian B L Segal |
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| Institution: | 1. Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital in Krakow, Pradnicka 80, Kraków, Poland;2. Department of Radiology and Diagnostic Imaging, John Paul II Hospital in Krakow, Pradnicka 80, Kraków, Poland;1. Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD, United States;2. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan;3. School of Medicine, National Yang-Ming University, Taipei, Taiwan;4. Division of Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Johns Hopkins University, Baltimore, MD, United States;5. Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan |
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| Abstract: | To determine the diagnostic value of Q-waves (greater than or equal to 0.04 seconds duration) in premature ventricular complexes (PVC's) for the presence of myocardial scar, we examined 12-lead electrocardiograms and multiple lead rhythm strips obtained before and after exercise at the time of thallium-201 myocardial imaging in 970 patients. PVC's were found in 233 patients, 112 of whom had fixed thallium-201 perfusion defects indicative of myocardial scar. PVC's occurring during exercise were excluded from the analysis. Twenty-one patients had Q-wave PVC's in one or more electrocardiographic leads. Of those, 14 patients (67%) had myocardial scar in the suggested location. Myocardial scar was more common among patients with Q-wave PVC's than in patients without (67% vs. 36%, p less than 0.01). However, only 6 of 13 patients (46%) with Q-wave PVC's but no diagnostic sinus beats actually had myocardial scar. The remaining seven patients had Q-wave PVC's, no myocardial scar, and no evidence of myocardial ischemia suggested by angina during exercise, exercise electrocardiogram or thallium-201 imaging. We conclude that although Q-wave PVC's indicate the presence of myocardial scar in 67% of patients, they yield little or no additional diagnostic information to that obtained from the sinus beats |
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