Ventricular late potentials are associated with the presence of viable myocardium after anterior myocardial infarction

Diego Tarricone, Alessandro Verzoni, Claudio Di Leo, Alberto Bestetti, Luca Tagliabue, Angelo Del Sole, Giorgio Cavenaghi, Gian Luigi Tarolo, Cesare Fiorentini, Federico Lombardi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The aim of the study was to evaluate the relationship between myocardial viability (MV) detected by TI-201 rest/redistribution protocol (RR-SPECT) and the presence of ventricular late potentials (VLPs) in acute myocardial infarction (AMI). We analyzed signal-averaged ECGs (SAECGs) in 28 patients (age 57 ± 10 years) with a first anterior AMI within 48 hours of symptoms (SAECG1) and prior to discharge (SAECG2). VLPs were defined according to the presence of filtered QRS (QRS-D) ≥ 114 ms and duration of low amplitude signals (LAS) ≥ 30 ms or root mean square voltage (RMS40) ≤ 25 μV, using a 25-Hz filter, or a duration of LAS ≥ 39 ms or RMS40 ≤ 20 μV, using a 40-Hz filter. RR-SPECT was performed 17 ± 6 days after AMI. Segments were considered viable when counts were ≥ 60% in early images or when a fill-in ≥ 10% was detectable on delayed images of those segments with a first count between 31% and 59%. Methods: Patients were divided into two groups: with MV (group 1 = 16 patients) if almost one third of segments appeared to be viable; without MV (group 2 = 12 patients). No difference was found between the two groups in SAECG1, whereas, using a 25-Hz filter, a greater QRS-D (106.6 ± 13.5 vs 93.5 ± 6 ms) and LAS (31.2 ± 8.7 vs 18.1 ± 6.4 ms) as well as a smaller RMS40 (43 ± 33.5 vs 71.3 ± 30.4 μV) characterized the SAECG2 of group 1. Sensitivity and specificity of VLPs in detecting MV were 31% and 100%. When using cut-off values derived from median distribution of the population (QRS-D ≥ 99 ms, LAS ≥ 24 ms and RMS40 ≥ 51 μV), sensitivity raised to 75% and specificity was 92% with a positive and negative predictive value of 92% and 73%. Conclusions: The presence of MV is associated with a greater incidence of VLPs. SAECG performed at the time of discharge may facilitate the identification of patients with MV after anterior AMI.

Original languageEnglish
Pages (from-to)172-178
Number of pages7
JournalAnnals of Noninvasive Electrocardiology
Volume5
Issue number2
Publication statusPublished - 2000

Keywords

  • Late potentials
  • Myocardial scintigraphy
  • Myocardial viability
  • Radionuclide imaging
  • Signal averaging
  • Thallium 201

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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