Persistent precordial S-T segment elevation has been assumed to be evidence of left ventricular aneurysm.
To evaluate this hypothesis, we examined the electrocardiograms and radionuclide ventriculograms of 374 consecutive patients referred to the nuclear cardiology laboratory for evaluation of ventricular function. Patients with major intraventricular conduction abnormalities, left and right bundle branch block, pacemaker-dependent rhythms and inferior wall aneurysms were excluded. Among 40 patients with persistent S-T segment elevation, 29 (73%) had left ventricular aneurysm, whereas aneurysm was present in only 21 (6%) of 334 patients without S-T segment elevation. There were 70 patients with Q wave anterior myocardial infarction. Among those patients with S-T segment elevation, 74% had left ventricular aneurysm, 47% had dyskinetic wall motion and 94% had akinetic wall motion. Among those patients without S-T segment elevation, 25% had left ventricular aneurysm, 8% had dyskinesis and 58% had akinesis. We conclude that the presence of persistent S-T segment elevation on the electrocardiogram is predictive of severe forms of wall motion abnormalities of the left ventricle including aneurysm.