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

Abstract

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.

Precordial ECG Lead Mispositioning: Its Incidence and Estimated Cost to Healthcare

“…However, PRWP incidence is reported in some studies as listed in Table 3. A study from the National Cancer Center of Korea reported a lower prevalence of PRWP ranging between 0.5% to 1.8%, depending upon the two criteria [21]. PRWP had been reported to be in the range of 15%-42% based upon different criteria [22].…”

Simple Laboratory and Clinical Parameters as Predictor for Electrocardiographic Abnormalities Among Hospitalized Patients with Chronic Kidney Disease: A Cross-Sectional Study

“…S wave of greater duration than R wave or greater than 40 ms in leads I and V6. Normal R peak time in leads V5 and V6 but greater than 50 ms in lead V1 [38] Poor R wave progression (PRWP) R-wave in V3 or V4 ≤2 mm [39] Left atrial enlargement (LAE) any one of the following: 1) P wave in any lead > 0.11s, 2) Notched P wave with interpeak duration > 0.04s (P mitrale), 3) P wave axis < 30°, 4) Area of negative P terminal force in lead V1 (NPTF-V1) > 0.04s•mm, or 5) Positive P terminal force in aVL (PPTF-aVL) > 0.5 mm [40] left ventricular hypertrophy (LVH) Sokolow-Lyon voltage criteria: the amplitude of the S wave in lead V1 was added to the largest amplitude of the R wave in either lead V5 or V6, with a value greater than or equal to 35 mm meeting criteria for LVH [41] Right atrial enlargement (RAE) Any one of the following: 1) P wave in inferior leads II, III, aVF > 2.5 mm or 2) Positive P wave in V1 > 1.5 mm [40] Right ventricular hypertrophy (RVH)…”