Diagnosis of non -Q wave myocardial infarction by inverse electrocardiology

Abstract

The purpose of our study was to validate the application of the original inverse electrocardiology method for diagnosis of non-Q wave myocardial infarction and also ventricular hypertrophy. This method was applied for conventional twelve lead ECG. The study cohort consisted 957 pts. 278 pts have non-Q wave miocardial infarction and miocardial infarction was not recognized by conventional ECG analysis methods. Proposed method enable to diagnose non-Q wave miocardial infarction with sensitivity 66%, specificity - 97% and possitive predictive value - 91%.Introduction The presence of an abnormal Q wave or the absence of the R wave are the usual diagnostic signs of myocardial infarction. These signs can be seen approximately in 70% cases of acute miocardial infarction and less frequently in the later stages of miocardial infarction [1,2,3,4] ST-T abnormalities, R wave regression are non-specific signs for miocardial infarction detection [5]. It was the specific goal of this study to validate the application of the inverse solution method for recognition of non-Q wave miocardial infarction and ventricular hypertrophy in conventional 12 lead ECG. Methods It is known that in inverse electrocardiography the single (having one meaning) solution do not exist if apriori the structure of the electrogenerator is not determined. Therefore our purpose was to receive physiologicaly significant solution and for this aim we applied the phenomenological multidipole model of the QRS complex generator. Taking into account the hypothesis of Burger and van Milaan, the potentials registred on body surface are the scalar product of two matrix: [A] = [B]-[C] (1) where a*j - element of matrix [A], the QRS complex value in i point of registration at j time moment; b - element of matrix [B], vector of k dipole in i lead; c - element of matrix [CI. value of k dipole moment at j time moment. When the elements of matrix [B] are known, the decisio [...].