Electrocardiographic findings in acute right ventricular infarction: Sensitivity and specificity of electrocardiographic alterations in right precordial leads V4R, V3R, V1, V2and V3

Abstract

To determine the sensitivity, specificity, predictive value and diagnostic efficiency of electrocardiographic alterations in the diagnosis of acute right ventricular infarction, 43 autopsy patients with acute myocardial infarction and an electrocardiogram including 12 leads plus leads V3R and V4R were studied. Group A included 21 patients with right ventricular infarction, of whom 14 (group AI) had posterior and 7 (group AII) had anterior right ventricular infarction. Group B included 22 patients without right ventricular infarction. Excluding group AII patients, the sensitivity of the presence of a Q wave reached 78.6% in lead V4R and decreased in leads V1 to V3; its specificity was low in all the leads. The sensitivity of ST segment elevation reached 100% in lead V4R and decreased in leads V1 to V3; its specificity was highest (68.2%) in leads V4R and V3R, its negative predictive value was 100% and its diagnostic efficiency was 80.6%. The criterion of ST segment elevation in lead V4R being higher than that in leads V1 to V3 was less sensitive (78.6%) than ST segment elevation in lead V4R alone, but its specificity reached 100%, its positive predictive value 100% and its diagnostic efficiency 91.7%. In conclusion, there are no electrocardiographic criteria to identify anterior right ventricular necrosis, but posterior right ventricular necrosis may be identified by the presence of a Q wave or ST segment elevation in the right precordial leads, reaching the highest sensitivity and specificity in lead V4R. The criterion of ST segment elevation in lead V4R being higher than that in leads V1 to V3 offers the highest specificity and efficiency in the diagnosis.

Universal Definition of Myocardial Infarction

“…29 In patients with inferior myocardial infarction it is advisable to record right precordial leads (V 3 R and V 4 R) seeking ST elevation in order to identify concomitant right ventricular infarction. 30 During an acute episode of chest discomfort, pseudonormalization of previously inverted T-waves may indicate acute myocardial ischemia. Pulmonary embolism, intracranial processes, or peri-/myocarditis may also result in ST-T abnormalities and should be considered (false positives) in the differential diagnosis.…”

Prognostic Value of Lead V 1 ST Elevation During Acute Inferior Myocardial Infarction

“…20 Similarly, ST elevation in leads V 7 through V 9 adds significantly to precordial ST depression in aiding the diagnosis of posterolateral AMI. [21][22][23] However, recording leads V 4 R and V 7 through V 9 is an additional step in the performance of a standard 12-lead ECG and, although recommended, 24,25 may not be routinely performed.…”

Diretrizes

“…A elevação do segmento ST nos infartos do VD aparece por um curto espaço de tempo devido ao baixo consumo de oxigênio da parede do VD. Geralmente, este infarto associa-se ao infarto da parede inferior e/ou lateral do ventrículo esquerdo 66 .…”