Correlation of anteroseptal ST elevation with myocardial infarction territories through cardiovascular magnetic resonance imaging

Research output: Contribution to journalArticle

Abstract

Background: Anteroseptal ST elevation myocardial infarction (STEMI) is traditionally defined on the electrocardiogram (ECG) by ST elevation (STE) in leads V1-V3, with or without involvement of lead V4. It is commonly taught that such infarcts affect the basal anteroseptal myocardial segment. While there are suggestions in the literature that Q waves limited to V1-V4 represent predominantly apical infarction, none have evaluated anteroseptal ST elevation territories. We compared the distribution of the myocardium at risk (MaR) in STEMI patients presenting with STE limited to V1-V4 and those with more extensive STE (V1-V6). Methods: We identified patients in the MITOCARE study presenting with a first acute STEMI and new STE in at least two contiguous anterior leads from V1 to V6. Patients underwent cardiac magnetic resonance (CMR) imaging three to five days after acute infarction. Results: Thirty-two patients met inclusion criteria. In patients with STE in V1-V4 (n = 20), myocardium at risk (MaR) > 50% was seen in 0%, 85%, 75%, 100%, and 90% in the basal anteroseptal, mid anteroseptal, apical anterior, apical septal segments, and apex, respectively. The group with STE in V1-V6 (n = 12), MaR > 50% was seen in 8%, 83%, 83%, 92%, and 83% of the same segments. Conclusions: Patients with acute STEMI and STE in leads V1-V4, exhibit MaR in predominantly apical territories and rarely in the basal anteroseptum. We found no evidence to support existence of isolated basal anteroseptal or septal STEMI. “Anteroapical” infarction is a more precise description than “anteroseptal” infarction for acute STEMI patients exhibiting STE in V1-V4.

Details

Authors
Organisations
External organisations
  • Baylor College of Medicine
  • University of Copenhagen
  • Nykøbing Falster Hospital
  • Henri Mondor Hospital
  • Oslo university hospital
  • Stavanger University Hospital
  • University of Bergen
  • University of Southern Denmark
  • University Medical Center Hamburg-Eppendorf
  • Skåne University Hospital
  • Aalborg University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems

Keywords

  • Cardiology, Electrocardiography, Magnetic resonance imaging, Myocardial infarction, ST elevations
Original languageEnglish
Pages (from-to)563-568
Number of pages6
JournalJournal of Electrocardiology
Volume51
Issue number4
Publication statusPublished - 2018 Jul 1
Publication categoryResearch
Peer-reviewedYes