The Value Of Electrocardiographic Poor R-wave Progression In Diagnosing Anterior Myocardial Infarction

【Objective】Poor R-wave progression (PRWP) is a common technical term onelectrocardiogram (ECG) interpretations, but its value in diagnosing anteriormyocardial infarction (MI) is disputed. The value of Electrocardiographic PRWP indiagnosing anterior MI was assessed in this study.【Methods】The resting electrocardiograms (ECGs) of consecutive patients undergoingsingle photon emission computed tomography(SPECT) with pharmacologic stresstest from 2000 to 2006 in Beijing Hospital were analyzed retrospectively. Subjectswith Q-wave anterior MI, q-wave in the right precordial leads, bundle branch block,Wolf-Parkinson-White syndrome, atrial fibrillation, ventricular hypertrophy or poorimage quality were excluded. Four standard PRWP criteria namely Marquette, Zema,Warner and Depace as well as 10 novel criteria from A to J were used to analyze theECGs, It was noted whether the patients met the PRWP criteria or not. X~2 methodswere used for comparing subjects'electrocardiographic and scintigraphic diagnosis.【Results】811 subjects met inclusion criteria. 64 subjects had scintigraphic anterior MI.The standard PRWP criteria were met in 2.7% to 18.7% of ECGs. The novel PRWPcriteria were met in 0% to 16.4% of ECGs. Of subjects meeting standard PRWPcriteria, 17.8% to 59.1% had anterior MI. Of subjects meeting novel PRWP criteria,0% to 45.8% had anterior MI. Of subjects with anterior MI, 23.3% to 42.2% metstandard PRWP criteria, 0% to 45.8% met novel PRWP criteria.Subjects with scinfigraphic posterior MI that can cause PRWP were exclued,756 subjects met inclusion criteria. 43 subjects had scintigraphic anterior MI. Thestandard PRWP criteria were met in 2.0% to 18.0% of ECGs. The novel PRWP criteria were met in 0.1% to 17.6% of ECGs. Of subjects meeting standard PRWPcriteria, 15.4% to 40.0% had anterior MI. Of subjects meeting novel PRWP criteria,0% to 42.1% had anterior MI. Of subjects with anterior MI, 14.0% to 48.8% metstandard PRWP criteria, 0% to 62.8% met novel PRWP criteria.No matter whether subjects with scintigraphic posterior MI were exclued, thestandard PRWP criteria and 8 of the 10 novel PRWP criteria A,B,C,D,E,H,I and J showed significant difference in the prevalence of anterior MI between thePRWP group and control group, but the sensitivity and positive predictive value ofthese criteria were very low, the Youden index was only 0.11～0.51.【Conclusions】the value of electrocardiographic poor R-wave progression in diagnosinganterior myocardial infarction is limited.