Anteroseptal or apical myocardial infarction: A controversy addressed using delayed enhancement cardiovascular magnetic resonance imaging

Aim: Delayed enhancement MRI (DE-MRI) of the heart has been shown to reliably identify areas of irreversible myocardial damage. We sought to determine if the term anteroseptal MI is appropriate by correlating electrocardiographic, angiographic, cine MRI and DE-MRI findings. Methods and Results: Nineteen patients admitted to our hospital with their first acute anterior MI and whose ECG showed new Q waves in leads V-1-V-4 were studied All patients underwent cardiac catheterization, cine MRI, and DE-MRI. The mean left ventricular ejection fraction was 53% +/- 16%. All 19 patients had evidence of delayed hyperenhancement in one or more myocardial segments (mean number of affected segments 5.5 +/- 2.1). The mean mass of hyperenhanced myocardium was 14 +/- 8 grams, or 10% +/- 6% of absolute LV mass. Nineteen (100%) and 15 (79%) patients showed evidence of delayed hyperenhancement of the apex and apical anterior segments respectively. Seven (37%) patients showed evidence of mid ventricular anteroseptal hyperenhancement and none had any hyperenhancement of basal anteroseptal segments. Conclusion: High resolution cardiac MRI applied in patients with acute infarction and new Q waves in leads V-1-V-4 demonstrates the presence of predominantly apical, but not isolated septal or anteroseptal infarction.