Lobeek, M. (Michelle) (2019) Diagnostic Value of the Electrocardiogram in the Assessment of Prior Myocardial Infarction. thesis, Medicine.
Full text available on request.Abstract
Purpose: The gold standard in the assessment of prior myocardial infarction (MI) is cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement (LGE). However, in daily practice, the electrocardiogram (ECG) is also often used in the evaluation of prior MI, although the diagnostic value is doubtful. This study evaluates the diagnostic value of the ECG in the assessment of prior MI. Method: In this retrospective study, the ECGs were collected of all patients who underwent CMR with LGE between January 2014 and December 2017. Twelve-lead ECGs were blinded and analyzed on signs of prior MI by two cardiologists. Disagreement of interpretation was solved by judgement of a third cardiologist. Sensitivity, specificity, positive- and negative predictive value were determined with the gold standard CMR with LGE. Inter-rater variability was analyzed using Cohen’s kappa. Results: Analyses were performed in 974 patients. The sensitivity and specificity of the ECG in the detection of MI were respectively 38.0% (95% confidence interval (CI) 31.6-44.8%) and 86.9% (95% CI 84.4-89.1%). The positive- and negative predictive value were respectively 43.6% (95% CI 36.4-50.9%) and 84.0% (95% CI 81.4-86.5%). In 170 ECG’s (17.5%), the two cardiologists disagreed on the presence or absence of MI. Inter-rater variability was moderate (kappa 0.52, 95% CI 0.45-0.58, p<0.001). Conclusion: If the ECG shows no signs of prior MI, the absence of MI is likely. However, the ECG has a low diagnostic value in the detection of prior MI. This study confirms that decisions concerning prior MI should not solely be based on an ECG.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor: and Martens F.M.A.C. MD PhD and 2nd supervisor: and Badings E. MD PhD |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:53 |
| Last Modified: | 25 Jun 2020 10:53 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1412 |
Actions (login required)
 |
View Item |