Electrocardiographic prediction of two-dimensional echocardiographic-determined left ventricular dyssynergy in acute myocardial infarction

The predictive values (PV) of QRS changes in the standard ECG in relation to two-dimensional echocardiographic (2-DE) left ventricular (LV) dyssynergy were determined in 63 patients with first acute myocardial infarction (AMI). The ability of the Selvester QRS criteria for AMI size estimation to predict dyssynergy in 5 aspects of the LV was determined. Dyssynergy in the anteroseptal, anterosuperior and apical aspects of the LV was best predicted by the presence of QRS criteria in leads V₂-V₃ (positive PV = 88, 93 and 96%, respectively). Normal wall motion in these 3 aspects of the LV was best predicted by the absence of QRS criteria in leads V₄-V₅ (negative PV = 69, 91 and 86%, respectively). Dyssynergy in the posterolateral aspect of the LV was best predicted by the presence of QRS criteria in leads I-aVL-V₆ (positive PV = 60%), and normal wall motion by the absence of QRS criteria in leads V₂-V₃ (negative PV = 59%). Inferior LV wall dyssynergy was predicted by the presence of QWRS criteria in both leads II-aVF (positive PV = 88%) and leads V₁-V₂ (posterior AMI criteria; positive PV = 94%). Normal inferior wall motion was best predicted by the absence of QRS criteria in leads II-aVF (negative PV = 79%). Thus, specific QRS changes as defined by the Selvester QRS scoring method following AMI are highly predictive of both the presence and absence of localized dyssynergy in the anterior and inferior aspects of the LV and moderately predictive of posterolateral dyssynergy.