PMID- 2794837
OWN - NLM
STAT- MEDLINE
DCOM- 19891117
LR  - 20190903
IS  - 0022-0736 (Print)
IS  - 0022-0736 (Linking)
VI  - 22
IP  - 4
DP  - 1989 Oct
TI  - R peak delay in V6. Diagnostic implications in coronary heart disease.
PG  - 349-58
AB  - Epimyocardial excitation is delayed in areas overlying infarcted myocardium. On 
      the assumption that a delayed R peak in V6 could indicate anterior myocardial 
      infarction (AMI) in the absence of diagnostic Q waves, the findings of 
      angiocardiography (n = 148) and thallium scanning (n = 46) of 194 patients with 
      suspected coronary heart disease (CHD) were compared with regard to two criteria: 
      A (R peak in V6 precedes S peak in V2, or both peaks occur simultaneously, n = 
      158) and B (R peak in V6 is later than S peak in V2 [R peak delay in V6], n = 
      36). Of 92 patients with unconfirmed CHD, 4 fit criterion B, and 3 of these had 
      hypertensive heart disease. In 102 patients with confirmed CHD, B was present in 
      15 of 79 evaluated with angiocardiography and in 17 of 23 patients who had 
      nuclear scanning. Anterior akinesis or dyskinesis was more prevalent in group B 
      (13 cases, 86%) than in group A (17 cases, 26.6%; p = 0.000), as were 
      irreversible anterior thallium defects, with 16 cases in group B (94.1% and 3 
      cases in group A (50%) (p = 0.016). Two of the three false positives had anterior 
      hypokinesis and one had hypertensive cardiovascular disease. B was less sensitive 
      (59.2%) but demonstrated a specificity of 95.2% and a positive predictive value 
      of 80.6% for the detection of AMI. If used in conjunction with C (poor or reverse 
      R wave progression from V1 to V4, notching at the R upstroke or rsR' in V4, V5, 
      or V6), sensitivity was decreased (38.6%) but false positives were eliminated 
      (specificity and positive predictive value reached 100%). Thus, in the setting of 
      CHD, B can be recommended as a marker of non-Q wave AMI, and its diagnostic 
      reliability is maintained, even in systemic arterial hypertension, if C is taken 
      into consideration.
FAU - Recke, S H
AU  - Recke SH
AD  - University Heart Centre, Erlangen, Federal Republic of Germany.
FAU - Eberlein, U
AU  - Eberlein U
FAU - Esperer, H D
AU  - Esperer HD
FAU - Gansser, R
AU  - Gansser R
FAU - von der Emde, J
AU  - von der Emde J
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Electrocardiol
JT  - Journal of electrocardiology
JID - 0153605
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Electrocardiography
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*diagnosis/physiopathology
EDAT- 1989/10/01 00:00
MHDA- 1989/10/01 00:01
CRDT- 1989/10/01 00:00
PHST- 1989/10/01 00:00 [pubmed]
PHST- 1989/10/01 00:01 [medline]
PHST- 1989/10/01 00:00 [entrez]
AID - 10.1016/0022-0736(89)90011-3 [doi]
PST - ppublish
SO  - J Electrocardiol. 1989 Oct;22(4):349-58. doi: 10.1016/0022-0736(89)90011-3.