The relationship between the resting electrocardiogram and left ventricular contractile pattern, as documented by angiography, was evaluated in 123 patients with coronary artery disease who underwent left ventriculography. Dyssnergy was present in 73/77 (95%) patients with pathologic Q waves on ECG recordings in contrast to 11/46 (24%; P < 0.01) without Q waves. The location of Q waves correlated well with the site of abnormal ventricular motion: antero apical dyssynergy in 40/40 (100%) patients with anterior myocardial infarction (MI) and infero apical dyssynergy in 25/28 (89%) with inferior MI. Four contraction patterns were defined: normal motion - 39 patients (35 without Q waves, four with inferior or posterior Q waves); segmental hypokinesis - 37 patients six without Q, 31 with Q); segmental akinesis - 26 patients (four without Q, 22 with Q); and localized dyskinesis - aneurysm in 21 patients (only one without Q, 20 with Q). The presence of ST elevation and T wave inversion along with Q waves were associated with dyskinesis or akinesis in 18/19 (95%) patients. The Q wave location reflected the type of dyssynergy: 32/40 (80%) patients with anterior MI had akinesis or dyskinesis, while 18/28 (64%) patients with inferior MI exhibited hypokinesis. Lateral extension of the Q wave in an anterior MI was related to the dyssynergy type (average V lead: 4.9 in dyskinesis and 3.3 in hypokinesis; P < 0.05) and extent (dyssynergy area/LV silhouette: 31% without Q to V3 and 58% to V5 or V6; P < 0.05). Dyssynergy area was larger in isolated anterior than inferior MI (42% and 23% of LV perimeter; P < 0.05) and largest in the anterior inferior MI (68%; P < 0.05). Dyssynergy was more extensive with Q and wave inversion than with Q alone (48% and 33% LV perimeter; P < 0.05). Thus, specific QRS and ST-T wave alterations, when monitoring coronary disease, accurately predict characteristics of LV dyssnergy: Q identifies its presence and location and Q with wave inversion estimates its nature and extent.
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine
- Physiology (medical)