Abstract 17015: When is a Pathological Q Wave Truly Pathological?
Introduction: Pathological Q waves are considered harbingers of cardiac pathology and should instigate comprehensive evaluation of athletes. Several definitions of the depth or duration of a Q wave exist, with disagreement between scientific bodies as to the most useful.
Objectives: 1. Determine the prevalence of pathological Q waves in large cohorts of the general population, athletes and patients with hypertrophic cardiomyopathy (HCM).
2. Identify the most accurate Q wave criterion.
Methods: ECGs were retrospectively analysed in consecutive cohorts of 10,008 healthy young athletes (14-35 years old), 2,994 healthy young non-athletes and 468 HCM patients.
Results: Pathological Q waves that fulfilled at least one of the 4 individual definitions (Table 1) were identified in 0.7% athletes (n = 75), 1.2% non-athletes (n = 36) and 22.6% patients with HCM (n = 106). In the healthy athletic and non-athletic population, all pathological Q waves (n = 111) met the >3mm depth definition. In contrast, the majority of pathological Q waves in HCM patients met the ≥40msec duration definition (n = 75; 70.75%).
We tested the ability of all 4 criteria to distinguish between health and disease in the entire cohort. Seattle and Refined had the best sensitivity for detecting HCM. Refined criteria however, had a significantly higher positive predictive value and 7 times lower false positive rate compared to Seattle. (Table 2)
Conclusion: Pathological Q waves are present in up to 1.2% of healthy young individuals and do not correlate with physical activity. Of the proposed criteria, the Refined criteria has the lowest false positive rate and should be utilised in the context of cardiac evaluation in young athletes.
Author Disclosures: K. Prakash: None. A. Malhotra: None. H. Dhutia: None. P. Siegenthaler: None. G. Nolan: None. H. Roth: None. M. Papadakis: None. S. Sharma: None.
- © 2015 by American Heart Association, Inc.