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controls. The infarct-related artery (IRA) was the LAD, LCx and RCA in 31%, 12%, and 57% of patients, respectively. All patients showed hyperenhancement on DECMR matching the IRA territory. The median infarct size was 11% (IQR 5-19) with a mean infarct transmurality of 57±16%. The sensitivity of echocardiography to detect SWMA was 80.3% in the acute, and 65.0% in the chronic phase; the specificity was 80.6%. In patients with unrecognized MI, infarcts were smaller (6% [IQR 3-12] vs. 15% [IQR 9-23], p<0.001, Figure 1) and less transmural (50±14% vs. 61±15%, p<0.001, Figure 2), left ventricular ejection fraction (LVEF) was higher (59±5% vs. 46±8%, p<0.001), and MI localization was more often non-anterior than anterior (83% vs. 63%, p<0.05). The strongest determinants of echocardiographic recognition of acute MI were LVEF (odds ratio per unit increase [OR] 0.77 (95% confidence interval [CI] 0.64-0.92), p<0.01), and LVEF and infarct size of chronic MI (OR 0.63 [95%CI 0.49-0.81], p<0.001 and OR 1.20 [95%CI 1.00-1.45], p=0.06, respectively). Segmental analysis showed a significant increase in SWMA with increasing infarct transmurality, both in acute as well as chronic MI (p<0.001). Conclusions

Unrecognized myocardial infarction by echocardiography in relation to infarct characteristics as assessed by cardiovascular magnetic resonance imaging