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Q waves in ischemic cardiomyopathy

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Abstract

Q waves may be observed in the absence of non-viable tissue. However, their scintigraphic translation in patients with ischemic cardiomyopathy (ICM) has not been properly assessed. This study sought to establish the determinants of Q waves in the absence of non-viable tissue and the diagnostic accuracy in this population. A retrospective study enrolling 487 consecutive patients (67.0 [57.4 – 75.4] years), with ICM, LVEF  < 40% and narrow QRS who underwent stress-rest 99 m-Tc SPECT was conducted. A 17-segment model for myocardium was used: Myocardium was divided in basal (1 to 6), mid (7 to 12), apical (13 to 16) and apex (17) segments. Non-viable tissue was defined as a severe perfusion defect without systolic thickening. Patients with Q waves (65.7%) had more non-viable tissue, more extensive scar and less ischemia. Q waves had a moderate correlation with non-viable tissue (AUC = 0.63) and were associated with the extension of the scar. After excluding patients with non-viable tissue in any myocardial segment, Q waves were observed in 51.9% of the patients, of which 78.1% had a scar fulfilling viability criteria. The presence of Q waves was associated with the location of these scars in a base-to-apex axis (OR = 1.88 [1.35–2.62] for segment towards the apex) and their extent (OR = 1.19 [1.05 – 1.35] for each segment). In patients with ICM, Q waves discriminate poorly viable from non-viable tissue. Q waves in this population may be due to extensive scars fulfilling viability criteria located in apical segments.

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Funding

No funding was provided to conduct this study.

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Authors and Affiliations

  1. Cardiology Department, Hospital Universitari Vall D’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig de la Vall d’Hebron, 08035, Barcelona, Spain

    Eduard Ródenas-Alesina, Pablo Jordán, Lorena Herrador, Carina Espinet-Coll & Maria Nazarena Pizzi

  2. Nuclear Medicine Department, Hospital Universitari Vall D’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain

    Guillermo Romero-Farina & Santiago Aguadé-Bruix

  3. Cardiology Department, Hospital Universitari Vall D’Hebron, Universitat Autònoma de Barcelona, CIBER de Epidemiología Y Salud Pública (CIBERESP), Barcelona, Spain

    Ignacio Ferreira-González

Authors
  1. Eduard Ródenas-Alesina
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  2. Pablo Jordán
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  3. Lorena Herrador
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  4. Carina Espinet-Coll
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  5. Maria Nazarena Pizzi
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  6. Guillermo Romero-Farina
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  7. Santiago Aguadé-Bruix
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  8. Ignacio Ferreira-González
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Correspondence to Eduard Ródenas-Alesina.

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Conflict of interest

E. Ródenas has received non-conditioned grants from Biotronik, Micropport, Johnson and Johnson, Sanofi and Sanofi Genzyme. No other conflicts of interests are declared.

Ethical approval

The study protocol was approved by the local ethics committee of Vall d’Hebron University Hospital (registered as PR(AG)377/2020).

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Ródenas-Alesina, E., Jordán, P., Herrador, L. et al. Q waves in ischemic cardiomyopathy. Int J Cardiovasc Imaging 37, 2085–2092 (2021). https://doi.org/10.1007/s10554-021-02172-9

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  • DOI: https://doi.org/10.1007/s10554-021-02172-9

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