Morphologic correlate of pathologic Q waves as assessed by gradient-echo magnetic resonance imaging

To assess the morphologic correlate of the presence and absence of pathologic Q waves in the electrocardiogram, 30 patients with and 17 patients without pathologic Q waves and chronic myocardial infarction (infarct age >4 months) and 15 patients without previous myocardial infarction but significant coronary artery disease (>70% diameter stenoses) were studied by gradient-echo magnetic resonance imaging (MRI). Short-axis MRI tomograms were evaluated on a segmental basis by calculating end-diastolic wall thickness and systolic wall thickening. All segments were graded transmural scar (end-diastolic wall thickness < end-diastolic wall thickness of a healthy control group [n = 21] - 2.5 SD and lack of systolic wall thickening), hypokinetic (end-diastolic wall thickness [greater than or equal to] end-diastolic wall thickness of the control group - 2.5 SD and systolic wall thickening [less than or equal to] 2 mm), or normal (end-diastolic wall thickness [greater than or equal to] end-diastolic wall thickness of the control group - 2.5 SD and systolic wall thickening >2 mm) by MRI criteria. Myocardial infarcts were defined as transmural if at least 1 segment fulfilled the MRI criteria for transmural scar. Of 30 patients with Q-wave infarction, 26 (87%) had a transmural defect, and 6 of 17 patients (35%) with non-Q-wave infarction had a transmural infarct. Segmental evaluation yielded 129 of 480 scar segments (27%) for patients with Q-wave infarction, 20 of 272 scar segments (7%) for patients with non-Q-wave infarction, and no scar segments for patients without previous myocardial infarction. The proportion of segments graded transmural scar was significantly (p