Clinical significance of changes in electrocardiographic R-wave voltage on chest leads in patients with acute anterior myocardial infarction

• Published in: Journal of electrocardiology Vol. 35; no. 3; pp. 173 - 180
• Main Authors: Isobe, Satoshi, Okada, Mitsuhiro, Ando, Akitada, Nanasato, Mamoru, Nonokawa, Makoto, Izawa, Hideo, Kondo, Takahisa, Hirai, Makoto, Yokota, Mitsuhiro, Tanahashi, Yoshifumi, Saito, Hidehiko
• Format: Journal Article
• Language: English
• Published: Orlando, FL Elsevier Inc 01.07.2002; Philadelphia, PA Churchill Livingstone; Elsevier Science Ltd
• Subjects: Biological and medical sciences; Cardiology. Vascular system; Coronary heart disease; Echocardiography; Electrocardiography; Fatty Acids; Female; Heart; Humans; Iodobenzenes; Male; Medical sciences; Middle Aged; Myocardial Infarction - physiopathology; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Human; R wave; Prognosis; Infarct; Acute; Variability; Cardiovascular disease; Anterior infarct; Coronary heart disease; Myocardial disease; Electrodiagnosis; Electrocardiography; Myocardium
• DOI: 10.1054/jelc.2002.33761
• ISSN: 0022-0736

This article aims to clarify the clinical significance of changes in electrocardiographic (ECG) R-wave voltage on chest leads from 1 to 4 weeks in patients with acute anterior myocardial infarction (MI) in combination with echocardiographic findings and dual scintigraphic findings. Seventy-one patients with acute anterior MI who underwent emergency revascularization were subjected to ECG and echocardiography, at both 1 and 4 weeks, and to thallium-201 (TI) and iodine-123-[beta ]-methyl-p-iodophenyl pentadecanoic acid (BMIPP) single-photon emission computed tomography (SPECT) about 1 week after the onset of MI. The total sum of ECG R-wave voltage on each chest lead was calculated. The mean defect ratio on TI and that on BMIPP derived from circumferential profile curve analysis were calculated. The percentage defect-discordant ratio of both SPECT images [(%) discordance on TI/BMIPP] was obtained. The percentage increase ratio of ECG R-wave voltage on chest leads [(%) increase of R wave] and the increase of left ventricular ejection fraction ([Delta ]EF) from 1 to 4 weeks were obtained. There were significant correlations between the (%) increase of R wave and the [Delta ]EF as well as between the (%) increase of R wave and the (%) discordance on TI/BMIPP (r = .63, P [lt ] .001; r = .74, P [lt ] .001). The reversibility of ECG R-wave voltage was related to cardiac functional improvement in addition to the discordance on the 2 images. Monitoring of changes in ECG R-wave voltage on chest leads is useful to detect the presence of myocardial viability and to evaluate functional evolution in patients with acute anterior MI.