In the past, a great deal of knowledge about ECG changes in acute coronary syndromes and IHD was based on pathologic correlations in animal work and autopsy studies. Ce-MRI has allowed a reassessment and reinterpretation of our common understanding of the ECG .
First, regarding Q waves and transmurality, several MRI studies have shown that the primary determinant of the presence of a Q-wave is the total size of the underlying infarction rather than its transmural extent .
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Second, ECG-derived estimates of infarct size correlate at best, only modestly with ce-MRI, overestimating small infarcts and underestimating large infarcts . Importantly, the lateral LV territories are electrically silent and therefore may present with little ECG alteration . Recently, a multi-specialist team has defined a new terminology of the LV walls and proposed a new ECG classification of Q-wave myocardial infarction based on cardiac MRI and angiographic correlations
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