Diagnostic value of the electrocardiogram in the assessment of prior myocardial infarction
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Neth Heart J https://doi.org/10.1007/s12471-020-01515-w
Diagnostic value of the electrocardiogram in the assessment of prior myocardial infarction M. Lobeek · E. Badings · M. Lenssen · R. Uijlings · K. Koster · E. van ’t Riet · F. M. A. C. Martens
Accepted: 20 October 2020 © The Author(s) 2020
Abstract Background The best available imaging technique for the detection of prior myocardial infarction (MI) is cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE). Although the electrocardiogram (ECG) still plays a major role in the diagnosis of prior MI, the diagnostic value of the ECG remains uncertain. This study evaluates the diagnostic value of the ECG in the assessment of prior MI. Methods In this retrospective study, data from electronic patient files were collected of 1033 patients who had undergone CMR with LGE between January 2014 and December 2017. After the exclusion of 59 patients, the data of 974 patients were analysed. Twelvelead ECGs were blinded and evaluated for signs of prior MI by two cardiologists separately. Disagreement in interpretation was resolved by the judgement of a third cardiologist. Outcomes of CMR with LGE were used as the gold standard. Results The sensitivity of the ECG in the detection of MI was 38.0% with a 95% confidence interval (CI) of 31.6–44.8%. The specificity was 86.9% (95% CI 84.4–89.1%). The positive and negative predictive
M. Lobeek () · E. Badings · R. Uijlings · F. M. A. C. Martens Department of Cardiology, Deventer Hospital, Deventer, The Netherlands [email protected] K. Koster Department of Radiology, Deventer Hospital, Deventer, The Netherlands E. van ’t Riet Teaching Hospital Deventer, Deventer Hospital, Deventer, The Netherlands M. Lenssen Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
value were 43.6% (95% CI 36.4–50.9%) and 84.0% (95% CI 81.4–86.5%) respectively. In 170 ECGs (17.5%), the two cardiologists disagreed on the presence or absence of MI. Inter-rater variability was moderate (κ 0.51, 95% CI 0.45–0.58, p < 0.001). Conclusion The ECG has a low diagnostic value in the detection of prior MI. However, if the ECG shows no signs of prior MI, the absence of MI is likely. This study confirms that a history of MI should not be based solely on an ECG. Keywords Myocardial infarction · Electrocardiogram · Sensitivity · Specificity · Predictive value
Introduction Despite a decrease in mortality rates, cardiovascular disease (CVD) is still one of the most important causes of death worldwide [1, 2]. In 2019, approximately 38,000 people died from CVD in the Netherlands, 22% died thereof from coronary artery diseases, including myocardial infarction (MI) [3]. To determine strategies for treatment for secondary prevention, it is important to detect prior MI. Today, the best available imaging technique for the assessment of MI is cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) [4, 5]. In acute situations, the electrocardiogram (ECG) has an important role in the diagnostic process [6, 7]. However, only a limited
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