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Vol 1, No 2 (2016)
Original article
Published online: 2016-12-02
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Pathological Q waves as an indicator of prior myocardial infarction in patients with coronary artery disease and diabetes mellitus: a comparison of the prevalence and diagnostic accuracy according to present and former criteria

Małgorzata Ostrowska, Jerzy Bellwon, Piotr Adamski, Marek Koziński, Piotr Niezgoda, Adam Ostrowski, Łukasz Fidor, Krzysztof Strojek, Marcin Gruchała
·
Medical Research Journal 2016;1(2):72-80.

open access

Vol 1, No 2 (2016)
ORIGINAL ARTICLES
Published online: 2016-12-02

Abstract

Introduction. Electrocardiography (ECG) is a widely used diagnostic method for identification of patients with previous myocardial infarction (MI). The ECG manifestation of prior MI is the presence of the pathological Q waves. Patients with coronary artery disease (CAD) and diabetes are at high risk of MI. The aim of this study was to compare the prevalence and diagnostic accuracy of the pathological Q waves as an indicator of prior MI in patients with CAD and diabetes according to the present and former criteria.

Methods. A cross-sectional, multi-centre study was conducted in outpatient clinics across Poland. Family physicians performed physical examinations, registered ECGs, and collected relevant information about onset of CAD and diabetes, presence and onset of hypertension, dyslipidaemia, heart failure, diabetic complications, history of MI, and pharmacotherapy. Centralised manual assessment of the obtained ECG tracings was performed. Two definitions of the pathological Q-waves were used — a present one according to the Universal Definition of MI and a former one based on the definition of MI developed by the World Health Organization.

Results. We enrolled 796 patients (48.1% women, mean age 67.5 ± 10.2 years, and 51.9% men, mean age 64.3 ± 10.3 years) into the study. There were 158 patients (19.8%) — 102 men (24.7%) and 56 women (14.6%), who met the present definition of the pathological Q waves and 106 patients (13.3%) — 74 men (17.9%) and 32 women (8.4%), who met the former definition of the pathological Q waves. The prevalence of the pathological Q waves varied due to the certain group of leads. It was highest in the inferior leads — 104 and 75 according to the present and former definitions, respectively. Of note, the rate of the pathological Q waves increased up to 2.6 times in the lateral leads after the introduction of the less restrictive present definition. Sensitivity of prior MI detection by means of the present and former criteria was 26.8% and 19.8%, and specificity was 87.0% and 92.8%, respectively. The application of the present and former definitions detected prior MI with 65.6% and 71.6% positive predictive value, and with 56.3% and 55.6% negative predictive value, respectively.

Conclusions. In the era of reperfusion therapy, ECG appears to be a poor diagnostic tool for detection of previous MI due to its low sensitivity. However, it may identify individuals without previous MI with rather high specificity. In diabetics with CAD, the present definition of the pathological Q waves increases sensitivity of prior MI detection by 7%, with a decrease in specificity by 6% as compared with the former definition.

Abstract

Introduction. Electrocardiography (ECG) is a widely used diagnostic method for identification of patients with previous myocardial infarction (MI). The ECG manifestation of prior MI is the presence of the pathological Q waves. Patients with coronary artery disease (CAD) and diabetes are at high risk of MI. The aim of this study was to compare the prevalence and diagnostic accuracy of the pathological Q waves as an indicator of prior MI in patients with CAD and diabetes according to the present and former criteria.

Methods. A cross-sectional, multi-centre study was conducted in outpatient clinics across Poland. Family physicians performed physical examinations, registered ECGs, and collected relevant information about onset of CAD and diabetes, presence and onset of hypertension, dyslipidaemia, heart failure, diabetic complications, history of MI, and pharmacotherapy. Centralised manual assessment of the obtained ECG tracings was performed. Two definitions of the pathological Q-waves were used — a present one according to the Universal Definition of MI and a former one based on the definition of MI developed by the World Health Organization.

Results. We enrolled 796 patients (48.1% women, mean age 67.5 ± 10.2 years, and 51.9% men, mean age 64.3 ± 10.3 years) into the study. There were 158 patients (19.8%) — 102 men (24.7%) and 56 women (14.6%), who met the present definition of the pathological Q waves and 106 patients (13.3%) — 74 men (17.9%) and 32 women (8.4%), who met the former definition of the pathological Q waves. The prevalence of the pathological Q waves varied due to the certain group of leads. It was highest in the inferior leads — 104 and 75 according to the present and former definitions, respectively. Of note, the rate of the pathological Q waves increased up to 2.6 times in the lateral leads after the introduction of the less restrictive present definition. Sensitivity of prior MI detection by means of the present and former criteria was 26.8% and 19.8%, and specificity was 87.0% and 92.8%, respectively. The application of the present and former definitions detected prior MI with 65.6% and 71.6% positive predictive value, and with 56.3% and 55.6% negative predictive value, respectively.

Conclusions. In the era of reperfusion therapy, ECG appears to be a poor diagnostic tool for detection of previous MI due to its low sensitivity. However, it may identify individuals without previous MI with rather high specificity. In diabetics with CAD, the present definition of the pathological Q waves increases sensitivity of prior MI detection by 7%, with a decrease in specificity by 6% as compared with the former definition.

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Keywords

electrocardiography, pathological Q waves, coronary artery disease, diabetes mellitus

About this article
Title

Pathological Q waves as an indicator of prior myocardial infarction in patients with coronary artery disease and diabetes mellitus: a comparison of the prevalence and diagnostic accuracy according to present and former criteria

Journal

Medical Research Journal

Issue

Vol 1, No 2 (2016)

Article type

Original article

Pages

72-80

Published online

2016-12-02

Page views

1351

Article views/downloads

2357

DOI

10.5603/MRJ.2016.0012

Bibliographic record

Medical Research Journal 2016;1(2):72-80.

Keywords

electrocardiography
pathological Q waves
coronary artery disease
diabetes mellitus

Authors

Małgorzata Ostrowska
Jerzy Bellwon
Piotr Adamski
Marek Koziński
Piotr Niezgoda
Adam Ostrowski
Łukasz Fidor
Krzysztof Strojek
Marcin Gruchała

References (26)
  1. White HD, Thygesen K, Alpert JS, et al. Writing Group on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction, Joint ESC/ACCF/AHA/WHF Task Force for Universal Definition of Myocardial Infarction, Authors/Task Force Members Chairpersons, Biomarker Subcommittee, ECG Subcommittee, Imaging Subcommittee, Classification Subcommittee, Intervention Subcommittee, Trials & Registries Subcommittee, Trials & Registries Subcommittee, Trials & Registries Subcommittee, Trials & Registries Subcommittee, ESC Committee for Practice Guidelines (CPG), Document Reviewers, Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction, Task Force for the Universal Definition of Myocardial Infarction, Writing Group on the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction, ESC Committee for Practice Guidelines (CPG). Third universal definition of myocardial infarction. Eur Heart J. 2012; 33(20): 2551–2567.
  2. Roberts R, Pratt CM, Alexander RW. Pathophysiology, recognition and treatment of acute myocardial infarction and its complications. In: Schlant RC, eds. Hurst’s the Heart: Arteries and Veins. McGraw-Hill, New York 1994: 1107–1184.
  3. Abdulla J, Brendorp B, Torp-Pedersen C, et al. TRACE study group (TRAndolapril Cardiac Evaluation). Does the electrocardiographic presence of Q waves influence the survival of patients with acute myocardial infarction? Eur Heart J. 2001; 22(12): 1008–1014.
  4. Furman MI, Dauerman HL, Goldberg RJ, et al. Twenty-two year (1975 to 1997) trends in the incidence, in-hospital and long-term case fatality rates from initial Q-wave and non-Q-wave myocardial infarction: a multi-hospital, community-wide perspective. J Am Coll Cardiol. 2001; 37(6): 1571–1580.
  5. White HD, Thygesen K, Alpert JS, et al. Writing Group on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction, Joint ESC/ACCF/AHA/WHF Task Force for Universal Definition of Myocardial Infarction, Authors/Task Force Members Chairpersons, Biomarker Subcommittee, ECG Subcommittee, Imaging Subcommittee, Classification Subcommittee, Intervention Subcommittee, Trials & Registries Subcommittee, Trials & Registries Subcommittee, Trials & Registries Subcommittee, Trials & Registries Subcommittee, ESC Committee for Practice Guidelines (CPG), Document Reviewers, Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction, Task Force for the Universal Definition of Myocardial Infarction, Writing Group on the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction, ESC Committee for Practice Guidelines (CPG), Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction, Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction, Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction. Circulation. 2007; 116(22): 2634–2653.
  6. Kannel WB, McGee DL, Kannel WB, et al. Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham study. Diabetes Care. 1979; 2(2): 120–126.
  7. Pyörälä K, Laakso M, Uusitupa M. Diabetes and atherosclerosis: an epidemiologic view. Diabetes Metab Rev. 1987; 3(2): 463–524.
  8. Whiteley L, Padmanabhan S, Hole D, et al. Should diabetes be considered a coronary heart disease risk equivalent? Diabetes Care. 2005; 28: 1588–1593.
  9. Juutilainen A, Lehto S, Rönnemaa T, et al. Type 2 diabetes as a "coronary heart disease equivalent": an 18-year prospective population-based study in Finnish subjects. Diabetes Care. 2005; 28(12): 2901–2907.
  10. Haffner SM, Lehto S, Rönnemaa T, et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998; 339(4): 229–234.
  11. Kannel WB. Diabetes and cardiovascular disease. The Framingham study. JAMA: The Journal of the American Medical Association. 1979; 241(19): 2035–2038.
  12. Nathan DM, Meigs J, Singer DE. The epidemiology of cardiovascular disease in type 2 diabetes mellitus: how sweet it is ... or is it? Lancet. 1997; 350 (Suppl 1): 14–19.
  13. Pekkanen J, Linn S, Heiss G, et al. Ten-year mortality from cardiovascular disease in relation to cholesterol level among men with and without preexisting cardiovascular disease. N Engl J Med. 1990; 322(24): 1700–1707.
  14. Rosengren A, Hagman M, Wedel H, et al. Serum cholesterol and long-term prognosis in middle-aged men with myocardial infarction and angina pectoris: A 16-year follow-up of the Primary Prevention Study in Gateborg, Sweden. European Heart Journal. 1997; 18(5): 754–761.
  15. Oğuz A, Damci T, Pehlivanoğlu S, et al. The impact of diabetes and coronary artery disease on mortality and morbidity in patients with hypertension. Turk Kardiyol Dern Ars. 2009; 37(4): 221–225.
  16. Ostrowska M, Bellwon J, Koziński M, et al. Prevalence of electrocardiographic left ventricular hypertrophy among patients with coronary artery disease and diabetes mellitus. Medical Research Journal. 2016; 1(1): 1–9.
  17. Hancock EW, Deal BJ, Mirvis DM, et al. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram: Part V: Electrocardiogram Changes Associated With Cardiac Chamber Hypertrophy: A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: Endorsed by the International Society for Computerized Electrocardiology. Circulation. 2009; 119(10): e251–e261.
  18. Parikh NI, Gona P, Larson MG, et al. Long-term trends in myocardial infarction incidence and case fatality in the National Heart, Lung, and Blood Institute's Framingham Heart study. Circulation. 2009; 119(9): 1203–1210.
  19. Horan LG, Flowers NC, Johnson JC. Significance of the diagnostic Q wave of myocardial infarction. Circulation. 1971; 43(3): 428–436.
  20. Lindvall K, Erhardt L, Sjogren A. Echo- and electrocardiographic findings in relation to autopsy in myocardial infarction. Clin Cardiol. 1982; 5(1): 51–61.
  21. Al-Mohammad A, Norton MY, Mahy IR, et al. Can the surface electrocardiogram be used to predict myocardial viability? Heart. 1999; 82(6): 663–667.
  22. Sandler LL, Pinnow EE, Lindsay J. The accuracy of electrocardiographic Q waves for the detection of prior myocardial infarction as assessed by a novel standard of reference. Clin Cardiol. 2004; 27(2): 97–100.
  23. Asch FM, Shah S, Rattin C, et al. Lack of sensitivity of the electrocardiogram for detection of old myocardial infarction: a cardiac magnetic resonance imaging study. Am Heart J. 2006; 152(4): 7422–7428.
  24. Nadour W, Doyle M, Williams RB, et al. Does the presence of Q waves on the EKG accurately predict prior myocardial infarction when compared to cardiac magnetic resonance using late gadolinium enhancement? A cross-population study of noninfarct vs infarct patients. Heart Rhythm. 2014; 11(11): 2018–2026.
  25. Abdulla J, Brendorp B, Torp-Pedersen C, et al. TRACE study group (TRAndolapril Cardiac Evaluation). Does the electrocardiographic presence of Q waves influence the survival of patients with acute myocardial infarction? Eur Heart J. 2001; 22(12): 1008–1014.
  26. Godsk P, Jensen JS, Abildstrøm SZ, et al. Prognostic significance of electrocardiographic Q-waves in a low-risk population. Europace. 2012; 14(7): 1012–1017.

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