Does the presence of Q waves on the EKG accurately predict prior myocardial infarction when compared to cardiac magnetic resonance using late gadolinium enhancement? A cross-population study of noninfarct vs infarct patients

EKG-defined scar, while ubiquitous for an infarct, has low sensitivity than CMR-LGE-defined scar. Unexpectedly, a significant number of pathological Q waves had absent infarct etiology, indicating high false positivity. Similarly, underrecognition of bona fide myocardial infarction frequently occurs, while 3-dimensional CMR volume of myocardial scar is far more predictive of a Q wave than of scar transmurality. This suggests that the well-regarded EKG may be a disservice when applied on a population basis, leading to inappropriate over or under downstream testing with wide socioeconomic implications.