Poor R-wave progression fails to detect anterior myocardial fibrosis in MESA

Area of Science:

• Cardiology
• Diagnostic Imaging
• Electrocardiography

Background:

• Poor R-wave progression (PRWP) on 12-lead ECG is traditionally linked to anterior myocardial injury.
• This interpretation is based on outdated, small, and potentially biased studies.
• The diagnostic accuracy of PRWP for anterior-wall fibrosis using modern Cardiac Magnetic Resonance (CMR) imaging is currently unknown.

Purpose of the Study:

• To evaluate the association between PRWP on ECG and anterior-wall fibrosis detected by CMR.
• To assess the diagnostic performance of PRWP in identifying myocardial fibrosis in a large, multiethnic cohort.

Main Methods:

• Analysis of participants from the Multi-Ethnic Study of Atherosclerosis (MESA) Examination 5, utilizing digital ECG and CMR data.
• PRWP was defined as RV3 ≤ 3 mm with RV3 > RV2.
• A historical Zema MI criterion was used for sensitivity analysis. Strict and liberal CMR references for anterior fibrosis were established.

Main Results:

• Out of 2950 participants, 5.5% exhibited PRWP.
• CMR-defined anterior fibrosis was present in 0.7% (strict) and 1.9% (liberal) of participants.
• Using the strict CMR reference, PRWP sensitivity was 0.0% and specificity was 94.4%. With the liberal reference, sensitivity was 5.3% and specificity was 94.4%.

Conclusions:

• Isolated PRWP on ECG did not demonstrate significant association with anterior-wall fibrosis identified by CMR in a large, multiethnic cohort.
• Current evidence suggests PRWP should not be used as a standalone diagnostic marker for anterior myocardial fibrosis.
• Further rigorous accuracy studies are required before PRWP can be reliably utilized for diagnosing anterior myocardial fibrosis.