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R peak delay in V6. Diagnostic implications in coronary heart disease
S H Recke1, U Eberlein, H D Esperer
1University Heart Centre, Erlangen, Federal Republic of Germany.
Journal of Electrocardiology
|October 1, 1989
Summary
A delayed R peak in V6 can indicate anterior myocardial infarction (AMI) without Q waves. Combining this with specific ECG criteria (C) improves diagnostic accuracy for AMI in coronary heart disease (CHD) patients.
Area of Science:
- Cardiology
- Electrocardiography
- Diagnostic Imaging
Background:
- Epimyocardial excitation is delayed over infarcted areas.
- Standard ECG criteria for anterior myocardial infarction (AMI) may be absent in some cases, particularly those without diagnostic Q waves.
- Investigating alternative ECG markers for AMI is crucial for accurate diagnosis and patient management.
Purpose of the Study:
- To evaluate the utility of a delayed R peak in V6 as an indicator of anterior myocardial infarction (AMI) in patients with suspected coronary heart disease (CHD).
- To compare the diagnostic performance of this ECG criterion, alone and in combination with another criterion (C), against angiocardiography and thallium scanning.
- To assess the reliability of the delayed R peak in V6 criterion in the presence of systemic arterial hypertension.
Main Methods:
- Retrospective analysis of 194 patients with suspected coronary heart disease (CHD).
- Comparison of ECG findings (delayed R peak in V6, criterion B; and criterion C) with angiocardiography (n=148) and thallium scanning (n=46).
- Evaluation of anterior akinesis/dyskinesis and irreversible thallium defects in relation to ECG criteria.
Main Results:
- Criterion B (delayed R peak in V6) showed a specificity of 95.2% and a positive predictive value of 80.6% for detecting AMI, with a sensitivity of 59.2%.
- Anterior akinesis/dyskinesis and irreversible anterior thallium defects were significantly more prevalent in patients with criterion B.
- Combining criterion B with criterion C (poor/reverse R wave progression) eliminated false positives, achieving 100% specificity and positive predictive value, though sensitivity decreased to 38.6%.
Conclusions:
- A delayed R peak in V6 (criterion B) is a reliable marker for non-Q wave anterior myocardial infarction (AMI) in patients with coronary heart disease (CHD).
- The diagnostic reliability of criterion B is maintained even in patients with systemic arterial hypertension.
- Incorporating criterion C alongside criterion B enhances diagnostic certainty by eliminating false positives, making it a valuable tool for diagnosing AMI.