Right Precordial Lead (V4R) ST-Segment Elevation is Associated With Worse Prognosis in Patients With Acute Anterior Myocardial Infarction

Barsheshet, Alon; Hod, Hanoch; Oieru, Dan; Goldenberg, Ilan; Sandach, Amir; Beigel, Roy; Glikson, Michael; Feinberg, Micha S.; Eldar, Michael; Matetzky, Shlomi

doi:10.1016/j.jacc.2011.03.035

Cited by 11 publications

(21 citation statements)

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“…However, with regard to our findings, this is not true for leads V3R/ V4R. Similarly, in a previous study, Barsheshet et al (12) investigated the association of proximal LAD involvement and concurrent anterior and RV MI and found no difference between two groups of patients with and without ST elevation in right precordial leads. As right precordial leads provide valuable prognostic information in patients with inferior MI, they are often recorded in this patient group (18).…”

Section: Discussioncontrasting

confidence: 72%

“…Also, there was a trend towards a higher rate of significant MR in patients with STE in leads V3R/V4R. Barsheshet et al (12) reported an abnormality of middle anteroseptal wall motion, detected by echocardiographic evaluations, in patients with concurrent STE in V4R. This synchrony may describe the higher rate of significant MR in our patients, which needs to be confirmed in future large studies.…”

Section: Discussionsupporting

confidence: 56%

“…The STE in V4R is suggested as a strong independent predictor of complications and mortality in patients with inferior MI (10), but its value in predicting the prognosis of patients with anterior STEMI has not been well studied and the data are limited. However, following the studies demonstrating a relatively high incidence of this condition, there is increasing interest in the literature about the consequences of RV MI (12,13,15). As reported in this study, concurrent right precordial ST elevation and anterior STEMI is not a rare finding and was present in 64.9% of our patients with anterior MI.…”

Section: Discussionsupporting

confidence: 54%

“…ST elevation in leads V3R and V4R is also described as an occasional finding in some patients with anterior ST elevation myocardial infarction (STEMI); however, the way in which it influences the prognosis of patients is a matter of controversy (10)(11)(12)(13)(14)(15). The fact that the LAD artery supplies anterior regions of the right ventricle could explain the occurrence of RVMI following LAD occlusion (16), but the possible location of stenosis in LAD artery is not well understood (12).…”

mentioning

confidence: 99%

“…The fact that the LAD artery supplies anterior regions of the right ventricle could explain the occurrence of RVMI following LAD occlusion (16), but the possible location of stenosis in LAD artery is not well understood (12).…”

mentioning

confidence: 99%

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ST-Segment Elevation in the Right Precordial Leads in Patients with Acute Anterior Myocardial Infarction

Pourafkari¹,

Joudi²,

Ghaffari³

et al. 2016

Balkan Med J

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Background: Elevation of ST segment in leads V3R/ V4R, which is commonly encountered in right ventricular myocardial infarction, may also occur in patients with anterior ST elevation myocardial infarction (STEMI). However, the clinical impact of this finding in the setting of anterior myocardial infarction is not well understood. Aims: We aimed to investigate the prognostic value of ST segment elevation in leads V3R/V4R in patients with first acute anterior myocardial infarction. Study Design: Prospective cohort study. Methods: Right precordial leads V3R/V4R were recorded in 111 patients admitted with first time anterior myocardial infarction. Patients were allocated into two groups based on the presence or absence of ST elevation in leads V3R/V4R. Demographic, biochemical and echocardiographic data, as well as the angiographic information, were recorded. In-hospital and 3 month mortality, and major adverse cardiac events (MACE), death, heart failure and ventricular dysrhythmia were also compared. Results: ST elevation in lead V3R or V4R was present in 72 out of 111 patients (64.9%). Involvement of the proximal part of the left anterior descending (LAD) artery was not different in the two groups (44.4% of patients with elevation vs. 53.8% of patients without elevation, p=0.22). Post-myocardial infarction complications, mortality and major adverse cardiac events were similar in the two groups. Left ventricular ejection fraction (LVEF) was significantly lower in patients with ST elevation in V3R/V4R (35 %±8 vs. 38 %±8, p=0.02). Twenty three out of 111 patients (20.7%) developed heart failure, which was similar in the two groups [16 (22.2%) of patients with ST elevation vs. 7 (17.9%) of patients without ST elevation, p=0.39]. Conclusion: Although ST elevation in V3R/V4R can be present in patients with left anterior descending artery occlusion, it does not seem to predict the prognosis. Lower left ventricular ejection fraction in this group may play a role in the long-term prognosis; however, this issue needs further investigation.

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Section: Discussioncontrasting

confidence: 72%

Section: Discussionsupporting

confidence: 56%