课件：心肌梗死的心电图诊断新进展.ppt

Fragmented QRS compared with Q-waves in the assessment of myocardial infarct Michael Rich, MD1; Mark Willcox, MD1; Joseph Lindsay, MD2; Anthony Fuisz, MD2 Introduction Methods Discussion Conclusions References Michael, M; Das, M. Fragmented QRS on a 12-lead ECG is a Sign of Acute or Recent Myocardial Infarction. Circulation. 2006;114:II 512. Blackburn, H. Electrocardiographic classification for population comparisons: The Minnesota code. Journal of Electrocardiology. 1969;2:1, 5-9. Results EKG notching (fQRS) in the absence of bundle-branch block may be a marker of altered ventricular depolarization secondary to myocardial scar. Abnormal Q-waves have been the standard EKG marker of prior myocardial infarction (MI). Based on a comparison to myocardial scintigraphy1, it has been proposed that fQRS is more sensitive and therefore has a better negative predictive value than Q-waves in detecting prior MI. This study was designed to compare fQRS and Q-waves, with CMR using delayed contrast hyperenhancement (DCH), as a marker of MI. The EKG’s of 146 stable patients (mean age 61 years, 98 male) who underwent CMR, including quantification of the volume of DCH, were reviewed by 2 independent readers blinded to this measurement. They recorded the presence of fQRS using published criteria and the presence of Q waves using the Minnesota Code criteria2. A fQRS was deemed to be present when, in a QRS <0.12 secs, there was an additional R wave (R’) or notching in the Q, R, or S wave in two or more contiguous leads in at least one coronary artery distribution. Q/QS waves on ECG were defined as per Minnesota Code criteria. Myocardial scar was quantified and localized by CMR delayed-contrast hyperenhancement and assumed as criterion standard. Sensitivity and specificity of fQRS and Q-waves were calculated for different scar sizes (>0%, >15%, and >30% of the myocardium) and location (global, anterior, inferior, and lateral walls). Q-waves were present in 38 (30%) patients, and fQRS we