Prevalence and Positive Predictive Value of Poor R-Wave Progression and Impact of the Cardiothoracic Ratio.
10.4070/kcj.2009.39.10.418
- Author:
Sung Hwan KIM
1
;
Mi Hyang KWAK
;
Hak Jin KIM
;
Gi Byoung NAM
;
Kee Joon CHOI
;
You Ho KIM
Author Information
1. Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea. youho@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Electrocardiography;
Thoracic radiography;
Myocardial infarction
- MeSH:
Coronary Artery Disease;
Electrocardiography;
Heart;
Humans;
Male;
Myocardial Infarction;
Prevalence;
Radiography, Thoracic
- From:Korean Circulation Journal
2009;39(10):418-422
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND AND OBJECTIVES: Poor 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 METHODS: We included 20,739 subjects who had routine medical examinations and applied the commonly used criteria (R-waves in V3 or V4 < or =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. RESULTS: The 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). CONCLUSION: The 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.
