Electrocardiographic and left ventriculographic correlations in 245 patients with coronary artery disease

Abstract The electrocardiograms and left ventriculograms of 245 patients with documented coronary artery disease were reviewed and compared. Currently accepted electrocardiographic criteria for anteroseptal, anterolateral, inferior, and true posterior transmural myocardial infarction imply a degree of precision that is not substantiated by our study. When electrocardiographic criteria for anteroseptal and anterolateral transmural myocardial infarction are combined to describe an anterior myocardial infarction, the sensitivity of the electrocardiogram in detecting anterior wall motion abnormalities by angiogram is 32% and the specificity is 98%. Furthermore, when the electrocardiogram indicates anterior myocardial infarction, the anterior wall and apex of the left ventricle are almost always involved together, with the anterior wall most commonly demonstrating hypokinesis and the apex manifesting dyskinesis. Similarly, when electrocardiographic criteria for inferior and true posterior transmural myocardial infarction are combined into posterior myocardial infarction, the sensitivity of the electrocardiogram in predicting wall motion abnormalities of the infero-posterior left ventricle is 40% and the specificity is 94%. In posterior myocardial infarction the posterobasal and diaphragmatic portion of the left ventricle are usually involved together, with both areas commonly manifesting hypokinesis. We conclude that the electrocardiogram is not sensitive in predicting the presence of left ventricular wall motion abnormalities.