Correlation between electrocardiographic subtypes of anterior myocardial infarction and regional abnormalities of wall motion

Background Examination of the electrocardiogram is the most widely used mea ns for diagnosis and early stratification of risk of acute myocardial infar ction (AMI). The classical classification of the subtypes of anterior AMI i s based on results of studies comparing the electrocardiograms recorded at various stages, mostly in the subacute or chronic stage of AMI, with autops y findings. Reports regarding the correlation between electrocardiographic findings in the acute phase and regional abnormality of wall motion (AWM) d etected by echocardiographic evaluation are sparse. Objective To investigate the relationship between the electrocardiographic and two-dimensional echocardiographic findings regarding patients with thei r first anterior AMI. Design and methods We studied 58 patients, 44 men and 14 women of mean age 61.5 +/- 14.6 years, with their first anterior AMI who had undergone two-di mensional echocardiographic evaluation within 48 h of admission. Deviation of ST-segment trace from baseline was measured manually 0.06 s after the J point for all leads on the admission electrocardiogram. ST-segment elevatio n in the various leads was correlated to the incidence of regional AWM dete cted by echocardiography. Results ST-segment elevations greater than or equal to 0.1 mV in V-1 leads were found for 21 (36.2%) patients. Basal anterior, basal anteroseptal, and basal septal AWM were seen more often for patients with than they were for patients without ST-segment elevation in V-1 (57 versus 16%, P = 0.003; 43 versus 13.5%, P = 0.03; 43 versus 11%, P = 0.01 respectively). In contrast to ST-segment elevation in lead V-1, the only statistically significant di fference in prevalence in the presence of regional AWM between patients wit h (n = 48) and without (n = 10) ST-segment elevation greater than or equal to 0.2 mV in lead V-2 was in the inferoapical region (87.5 versus 40%; P = 0.003), ST-segment elevation greater than or equal to 0.1 mV in leads aVL a nd V-5 was found for 11 (19%) and 23 (40%) patients, respectively. There wa s no correlation between either lateral or apical regional AWM and the pres ence of ST-segment elevation in the anterolateral leads except for mid-late ral AWM, which was more often detected for patients with than it was for pa tients without ST-segment elevation in aVL leads (36.3 versus 6.4%, P = 0.0 26). Conclusions ST-segment elevation in lead V-1 during the acute phase of ante rior AMI is associated with a high incidence of regional AWM in the basal a nterior, anteroseptal, and anterior regions, whereas ST-segment elevation i n lead V-2 is more often associated with AWM in the inferoapical region. ST -segment elevation in aVL leads is related to mid-lateral regional AWM. Cor on Artery Dis 11:489-493 (C) 2000 Lippincott Williams & Wilkins.