Poor R wave progression in the precordial leads: Clinical implications for the diagnosis of myocardial infarction

DePace, Nicholas L.; Colby, Jay M.; Hakki, A‐Hamid; Manno, Bruno V.; Horowitz, Leonard N.; Iskandrian, Abdulmassih S.

doi:10.1016/s0735-1097(83)80332-5

Cited by 39 publications

(23 citation statements)

References 19 publications

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“…The sum of R-wave in lead V1 to V6 was measured in each patient. PRWP was defined as RV3 ≤ 3 mm according to the DePace criteria [3].…”

Section: Methodsmentioning

confidence: 99%

“…The role of 12-lead electrocardiogram (ECG) in diagnosing myocardial infarction (MI) is well established [1], and poor R-wave progression (PRWP) is interpreted as the probable anterior MI [2], [3]. However, regeneration of R-wave or disappearance of Q-wave sometimes occurs after MI especially in the coronary intervention era [4], [5], [6], [7], [8].…”

Section: Introductionmentioning

confidence: 99%

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Poor R-wave progression and myocardial infarct size after anterior myocardial infarction in the coronary intervention era

Kurisu

Iwasaki

Watanabe

et al. 2015

IJC Heart & Vasculature

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BackgroundRegeneration of R-wave or disappearance of Q-wave sometimes occurs after myocardial infarction (MI) especially in the coronary intervention era. We assessed the impact of poor R-wave progression (PRWP) or residual R-wave in precordial leads on myocardial infarct size in patients with prior anterior MI treated with coronary intervention.MethodsFifty-three patients with prior anterior MI and 20 age- and sex-matched patients without underwent electrocardiogram (ECG), myocardial perfusion single photon emission tomography (SPECT) and echocardiography. Poor R-wave progression (PRWP) was defined as RV3 ≤ 3 mm.ResultsR-wave was significantly lower in all precordial leads in patients with prior anterior MI than those without. Among 53 patients with prior anterior MI, 33 patients had PRWP, and the remaining 20 patients did not. Patients with PRWP had larger sum of defect score (17.5 ± 8.6 vs 7.6 ± 10.3, p < 0.001) and lower left ventricular ejection fraction (LVEF) (46.1 ± 9.8% vs 55.2 ± 12.9%, p < 0.01) than those without. The sum of R-wave in lead V1 to V6 inversely correlated with the sum of defect score (r = − 0.56, p < 0.001), and positively correlated with LVEF (r = 0.45, p < 0.001).ConclusionOur data suggested that residual R-wave during the follow-up period reflected myocardial infarct size and left ventricular systolic function well in patients with prior anterior MI treated with coronary intervention.

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“…The sum of R-wave in lead V1 to V6 was measured in each patient. PRWP was defined as RV3 ≤ 3 mm according to the DePace criteria [3].…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Poor R-wave progression and myocardial infarct size after anterior myocardial infarction in the coronary intervention era

Kurisu

Iwasaki

Watanabe

et al. 2015

IJC Heart & Vasculature

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“…Clinical studies have shown that after revascularization in patients with acute myocardial infarction, R wave amplitude in ECG increased [19], [20]. Patients with small or absent initial R waves in the anterior chest leads, resulting in QS complexes or “poor R wave progression,” could also be diagnosed as myocardial infarction [21]–[23].…”

Section: Introductionmentioning

confidence: 99%

Decreases in Electrocardiographic R-Wave Amplitude and QT Interval Predict Myocardial Ischemic Infarction in Rhesus Monkeys with Left Anterior Descending Artery Ligation

et al. 2013

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Clinical studies have demonstrated the predictive values of changes in electrocardiographic (ECG) parameters for the preexisting myocardial ischemic infarction. However, a simple and early predictor for the subsequent development of myocardial infarction during the ischemic phase is of significant value for the identification of ischemic patients at high risk. The present study was undertaken by using non-human primate model of myocardial ischemic infarction to fulfill this gap. Twenty male Rhesus monkeys at age of 2–3 years old were subjected to left anterior descending artery ligation. This ligation was performed at varying position along the artery so that it produced varying sizes of myocardial infarction at the late stage. The ECG recording was undertaken before the surgical procedure, at 2 h after the ligation, and 8 weeks after the surgery for each animal. The correlation of the changes in the ECG waves in the early or the late stage with the myocardial infarction size was analyzed. The R wave depression and the QT shortening in the early ischemic stage were found to have an inverse correlation with the myocardial infarction size. At the late stage, the R wave depression, the QT prolongation, the QRS score, and the ST segment elevation were all closely correlated with the developed infarction size. The poor R wave progression was identified at both the early ischemic and the late infarction stages. Therefore, the present study using non-human primate model of myocardial ischemic infarction identified the decreases in the R wave and the QT interval as early predictors of myocardial infarction. Validation of these parameters in clinical studies would greatly help identifying patients with myocardial ischemia at high risk for the subsequent development of myocardial infarction.

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“…This is the first study to investigate this topic and suggest a reasonable cause of PRWP, i.e., a low cardiothoracic ratio. The prevalence of PRWP in the general population (0.5% by the Marquette criterion or 1.8% by the simple criterion based on R-wave amplitude of only two precordial leads) was even lower than in hospitalized adult patients (10%) or in patients examined for CAD (8%) 2)8). Subjects with PRWP tend to be female, younger, weigh less, and shorter in height than those without PRWP.…”

Section: Discussionmentioning

confidence: 86%

Prevalence and Positive Predictive Value of Poor R-Wave Progression and Impact of the Cardiothoracic Ratio

et al. 2009

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Background and ObjectivesPoor R-wave progression (PRWP) is a common electrocardiographic diagnosis. However, the diagnostic usefulness of PRWP for coronary artery disease (CAD) and the plausible explanation for subjects with normal heart function are unclear.Subjects and MethodsWe included 20,739 subjects who had routine medical examinations and applied the commonly used criteria (R-waves in V3 or V4 ≤2 mm) and the Marquette criteria in the current study. Subjects with PRWP by the Marquette criteria, but with no evidence of specific causes, were identified. Healthy age- and gender-matched controls were selected randomly for comparing cardiothoracic ratios.ResultsThe commonly used criteria in practice were met by 372 of the 20,739 subjects (1.8%). The Marquette criteria were met by 96 subjects (0.5%), and 82 of who agreed to medical evaluation. Five subjects had known CAD and only one subject was shown to have a silent myocardial infarction by additional testing. Therefore, the positive predictive value of PRWP for CAD was 7.3% (6/82) based on the Marquette criteria. As compared with the control group, the subjects with PRWP had a significantly low cardiothoracic ratio (0.425 vs. 0.445, p<0.05), especially among the male group (0.454 vs. 0.407, p=0.02).ConclusionThe positive predictive value of PRWP for CAD in the general population is so low that additional tests for diagnosis may be unreasonable. In addition, a low cardiothoracic ratio could be a plausible explanation of PRWP in subjects without any identifiable cause.

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Poor R wave progression in the precordial leads: Clinical implications for the diagnosis of myocardial infarction

Cited by 39 publications

References 19 publications

Poor R-wave progression and myocardial infarct size after anterior myocardial infarction in the coronary intervention era

Poor R-wave progression and myocardial infarct size after anterior myocardial infarction in the coronary intervention era

Decreases in Electrocardiographic R-Wave Amplitude and QT Interval Predict Myocardial Ischemic Infarction in Rhesus Monkeys with Left Anterior Descending Artery Ligation

Prevalence and Positive Predictive Value of Poor R-Wave Progression and Impact of the Cardiothoracic Ratio

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