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Poor evidence for poor R wave progression in coronary disease: A scoping review
José Nunes de Alencar1, Eduardo Ferreira Amorim2, Matheus Kiszka Scheffer1
1Electrocardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
Insights
Electrocardiogram findings like poor R wave progression (PRWP) and reversed R wave progression (RRWP) lack strong evidence for diagnosing coronary artery disease. Future research needs well-designed studies to confirm their diagnostic accuracy.
Area of Science:
- Cardiology
- Diagnostic Electrocardiography
Background:
- Poor R wave progression (PRWP) and reversed R wave progression (RRWP) are electrocardiographic findings historically linked to anterior wall fibrosis or chronic coronary artery disease.
- The existing evidence supporting these associations requires critical evaluation regarding its quantity and quality.
Purpose of the Study:
- To conduct a scoping review assessing the diagnostic significance of PRWP and RRWP.
- To explore the research landscape, including study populations, methodologies, and knowledge gaps concerning these ECG phenomena and their link to coronary artery disease.
Main Methods:
- A comprehensive literature search was performed across major databases (PubMed, Web of Science, Scopus).
- Included studies focused on PRWP or RRWP in the context of myocardial infarction, ischemia, or fibrosis, irrespective of publication date or language.
Main Results:
- Only 20 studies met the inclusion criteria, revealing a significant scarcity of data.
- No high-quality accuracy studies were identified; existing research is hampered by methodological limitations, notably selection bias.
- Prevalence and prognostic studies exhibited considerable heterogeneity in definitions and outcomes, leading to a high risk of bias.
Conclusions:
- The limited evidence base for PRWP and RRWP as diagnostic markers for coronary artery disease warrants cautious clinical interpretation.
- Further well-designed case-control studies are essential to establish the diagnostic accuracy of these ECG markers.
- Clinical reliance on PRWP/RRWP for diagnosing anterior infarction should be discouraged until robust evidence emerges, highlighting a gap in evidence-based practice.
Background:
Poor R wave progression (PRWP) and reversed R wave progression (RRWP) have long been noted in electrocardiograms as potential indicators of anterior wall fibrosis or chronic coronary artery disease; however, the quantity and quality of evidence supporting these associations warrants closer examination.
Objective:
The aim of this scoping review is to assess the breadth of evidence regarding the diagnostic significance of PRWP and RRWP, explore the extent of research, study populations and methodologies, and the presence of gaps in knowledge regarding these electrocardiographic phenomena and their association with coronary diseases.
Design:
We conducted a comprehensive search across PubMed, Web of Science, and Scopus, covering literature on PRWP or RRWP in the context of myocardial infarction, ischemia, or fibrosis from any time period and in any language.
Results:
A total of 20 studies were included in this review, highlighting the severe paucity of data. No high-quality accuracy studies have been identified, and existing research suffers from methodological issues, in particular selection bias. Prevalence and prognostic studies showed significant heterogeneity in terms of definitions and outcomes, which contributes to an alarming risk of bias.
Conclusions:
The lack of solid evidence for PRWP and RRWP as diagnostic markers for acute and chronic coronary artery disease necessitates caution in clinical interpretation. Future research should focus on well-designed case-control studies to clarify the diagnostic accuracy of these markers. Until robust evidence is available, the reliance on PRWP/RRWP for diagnosing anterior infarction should be discouraged, reflecting a gap between clinical practice and evidence-based medicine.
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