Journal of electrocardiology · 2026
Pathological Q waves in anterior myocardial infarction: A marker of infarct extent rather than location.
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Aslanger Emre K, Gençol Akçay Gamze, Acaroğlu Şeyma, İnan Duygu, Taşdelen Neslihan, Özkök Serçin, Akaslan Dursun, Türer Cabbar Ayça, Çatal Sema, Kamalı Ömer Faruk, Uysaler Eren, Yıldırımtürk Özlem, Değertekin Muzaffer
Аннотация
BACKGROUND: Pathological Q waves have traditionally been used to localize myocardial infarction (MI), although their anatomical specificity remains uncertain. We investigated the relationship between Q-wave distribution and cardiac magnetic resonance (CMR)-defined myocardial infarct burden after anterior MI.
METHODS: We analyzed 102 patients with first anterior ST-elevation MI. Individual Q waves and established anterior Q wave patterns were compared with segmental late gadolinium enhancement (LGE).
RESULTS: Individual Q waves showed broad, overlapping relationships with LGE-defined infarct burden; after false-discovery-rate correction, only Q waves in V1 remained significantly associated with basal anteroseptal and apical septal LGE-defined infarct burden. Established Q wave patterns showed substantial anatomical overlap but a clear gradient in infarct burden. Across the four-level classification based on the most lateral precordial lead with a pathological Q wave (none, V1-V2 only, up to V3, or extending to V4-V6), infarct size increased from 6% to 14%, 17%, and 18% (P for trend<0.001), mid-ventricular LGE burden from 75 to 125, 150, and 175 percentage-points (P < 0.001), and apical LGE burden from 100 to 125, 200, and 200 percentage-points (P < 0.001). LVEF declined across categories (P for trend = 0.004).
CONCLUSIONS: In anterior MI, pathological Q wave distribution showed limited correspondence with discrete myocardial territories but was associated with increasing infarct size and greater mid-apical LGE-defined infarct burden, suggesting that Q-wave distribution may be better interpreted as a marker of infarct extent than as a geographical map of infarct location. External validation of this simplified extent-based classification is warranted.
METHODS: We analyzed 102 patients with first anterior ST-elevation MI. Individual Q waves and established anterior Q wave patterns were compared with segmental late gadolinium enhancement (LGE).
RESULTS: Individual Q waves showed broad, overlapping relationships with LGE-defined infarct burden; after false-discovery-rate correction, only Q waves in V1 remained significantly associated with basal anteroseptal and apical septal LGE-defined infarct burden. Established Q wave patterns showed substantial anatomical overlap but a clear gradient in infarct burden. Across the four-level classification based on the most lateral precordial lead with a pathological Q wave (none, V1-V2 only, up to V3, or extending to V4-V6), infarct size increased from 6% to 14%, 17%, and 18% (P for trend<0.001), mid-ventricular LGE burden from 75 to 125, 150, and 175 percentage-points (P < 0.001), and apical LGE burden from 100 to 125, 200, and 200 percentage-points (P < 0.001). LVEF declined across categories (P for trend = 0.004).
CONCLUSIONS: In anterior MI, pathological Q wave distribution showed limited correspondence with discrete myocardial territories but was associated with increasing infarct size and greater mid-apical LGE-defined infarct burden, suggesting that Q-wave distribution may be better interpreted as a marker of infarct extent than as a geographical map of infarct location. External validation of this simplified extent-based classification is warranted.