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A diagnosis of an old inferior wall myocardial infarction (IMI) by computerized interpretation of a routinely performed electrocardiogram (ECG) may lead to further consultations and imaging studies to confirm or refute that diagnosis. This study was designed to assess the value of abnormal Q waves combined with repolarization abnormalities in inferior leads for the diagnosis of an old IMI as confirmed by imaging studies. Methods: Fifty-six patients, in whom computerized interpretation of the ECG resulted in the diagnosis of old IMI, and in whom imaging studies were also available, were included in this study. ECGs were interpreted using the MUSEGE system. These ECGs were also analyzed by manually measuring the depth and the width of the Q waves and morphology of ST and T-wave changes in inferior leads. Echocardiograms and nuclear medicine cardiac imaging were performed and interpreted using standard equipment and techniques. Measures of accuracy were calculated and reported with 95% exact binomial confidence intervals (CI). Results: Computerized interpretation of the ECGs leading to the diagnosis of old IMI when compared with IMI confirmed by imaging studies, had a positive predictive value of 52.8% (95% exact CI: 35.5%-69.6%). Adding the manually measured Q waves wider than 40 msec and amplitude of -0.2 mV and repolarization abnormalities in leads II, III and aVF increased the positive predictive value of the test to 86.2% (95% exact CI: 68.3%-96.1%). Conclusions: These results suggest that the computerized interpretation of ECG results in a high rate of false positive readings of old IMI. Presence of diagnostic Q waves in inferior leads, if accompanied by repolarization abnormalities, improves the accuracy of the ECG for the diagnosis of old IMI.

international journal of clinical cardiology

Enhancing the Accuracy of Computerized Interpretation of Old Inferior Wall Myocardial Infarction in a Routine or Preoperative Electrocardiogram by Analyzing Repolarization Abnormalities and Q Waves in Leads II, III and aVF