Quantitative assessment of myocardial infarction: On the relationship between anatomy and electrophysiology using MRI and ECG

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Abstract

Both presence and extent of myocardial infarction are important prognostic factors for mortality and quality of life in patients with ischemic heart disease. Thus, it is of great clinical importance to be able to diagnose and characterize myocardial infarction. One way to diagnose myocardial infarction is by using the 12-lead electrocardiogram(ECG). For estimation of infarct size and location from infarctrelated ECG changes, the so called Selvester QRS scoring system can be used. This system is based on a forwardmodeling of the myocardial activation sequence. To further develop QRS scoring and for better understanding the pathophysiologic basis for infarct-related ECG changes, it is fundamental to understand how anatomic infarct characteristics relate to changes in the 12-lead ECG. The current reference standard for non-invasive visualization of myocardial infarction is delayed contrast-enhanced magnetic resonance imaging (DE-MRI). Hence, DEMRI can be used to define the anatomic correlate to infarct-related QRS changes. Paper I demonstrated that there was a good correlation between QRS score and infarct size by DE-MRI in patients with reperfused first-time infarction. Furthermore, the data showed that QRS score was related to infarct transmurality, whereas presence of Q waves was not indicative of transmural infarction. Indeed, Paper II revealed that the endocardial extent of infarction was a stronger determinant for presence of pathological Q waves than was infarct transmurality in patients with reperfused first-time infarction. In Paper III, the sequential changes of the infarction, left ventricular function and QRS score were studied in patients with reperfused first-time infarction. It was shown that almost two thirds of the total decrease in infarct size seen after one year occurred during the first week after infarction. Furthermore, regional wall thickening was shown to decrease progressively with increased infarct transmurality. Also, the timing and magnitude of decrease in infarct size assessed by DE-MRI was shown to correlate to the decrease in QRS score. Finally, Paper IV demonstrated that in patients with chronic anterior infarction, frequently suffering from severe remodeling and left ventricular aneurysm, QRS score was only moderately correlated to infarct size assessed by DE-MRI. In summary, DE-MRI has been used to describe the anatomical correlate to infarct-related QRS changes in acute, evolving, and healed myocardial infarction.
Original languageEnglish
QualificationDoctor
Awarding Institution
  • Clinical Physiology (Lund)
Supervisors/Advisors
  • Arheden, Håkan, Supervisor
Award date2006 Sep 30
Publisher
Print ISBNs91-85559-32-6
Publication statusPublished - 2006

Bibliographical note

Defence details

Date: 2006-09-30
Time: 09:00
Place: Föreläsningssal 1, Lund University Hospital

External reviewer(s)

Name: Jennings, Robert
Title: Professor
Affiliation: Duke University Medical Center, Durham, NC, USA

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<div class="article_info">H Engblom, E Hedström, E Heiberg, GS Wagner, O Pahlm and H Arheden. <span class="article_issue_date">2005</span>. <span class="article_title">Size and transmural extent of first-time reperfused myocardial infarction assessed by cardiac magnetic resonance can be estimated by 12-lead electrocardiogram.</span> <span class="journal_series_title">Am Heart J.</span>, <span class="journal_volume">vol 150</span> <span class="journal_pages">pp 1-9</span>.</div>
<div class="article_info">H Engblom, MB Carlsson, E Hedström, E Heiberg, M Ugander, GS Wagner and H Arheden. <span class="article_issue_date"></span>. <span class="article_title">The endocardial extent of reperfused first-time myocardial infarction is more predictive of pathologic Q waves than is transmurality: A magnetic resonance imaging study.</span> (submitted)</div>
<div class="article_info">H Engblom, E Hedström, E Heiberg, GS Wagner, O Pahlm and H Arheden. <span class="article_issue_date"></span>. <span class="article_title">Time course and magnitude of infarct involution, functional recovery and electrocardiographic changes in patients with reperfused first myocardial infarction.</span> (submitted)</div>
<div class="article_info">H Engblom, GS Wagner, RM Setser, RH Selvester, T Billgren, J Kasper, C Maynard, O Pahlm, H Arheden and RD White. <span class="article_issue_date">2003</span>. <span class="article_title">Quantitative clinical assessment of chronic anterior myocardial infarction with delayed enhancement magnetic resonance imaging and QRS scoring.</span> <span class="journal_series_title">Am Heart J.</span>, <span class="journal_volume">vol 146</span> <span class="journal_pages">pp 359-66</span>.</div>

Subject classification (UKÄ)

  • Respiratory Medicine and Allergy
  • Cardiac and Cardiovascular Systems

Keywords

  • Fysiologi
  • Physiology
  • medicinsk instrumentering
  • tomografi
  • radiologi
  • Klinisk fysiologi
  • magnetic resonance imaging
  • tomography
  • medical instrumentation
  • Clinical physics
  • radiology
  • electrocardiography
  • myocardial infarction
  • ischemic heart disease
  • Cardiovascular system
  • Diagnostics
  • Diagnostik
  • Kardiovaskulära systemet

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