La onda R prominente en V1 pero no en V2 es un signo específico de infarto transmural lateral grande

Introduction and objectives

In the absence of right ventricular hypertrophy or bundle-branch block, a prominent R wave in V₁ or V₂ is considered to reflect a lateral myocardial infarction. We investigated the differences in infarct location, size and transmural extent between patients with prominent R wave in V₁ and those with prominent R wave in V₂.

Methods

We studied 50 patients with a previous first infarction involving left ventricular inferior and/or lateral wall at contrast-enhanced magnetic resonance.

Results

A prominent R wave in V₁ was present in 8 patients (16%), in V₂ in 23 (46%). At magnetic resonance, the infarction involved the inferior wall in 11 patients (22%), the lateral wall in 6 (12%), and both walls in 33 patients (66%). The sensitivity of a prominent R wave in V₁ in detecting a lateral infarction was low (17.9%), while the specificity was high (90.9%). The sensitivity and specificity of a prominent R wave in V₂ were 46.2% and 54.5%, respectively. In patients with a prominent R wave in V₁, infarct size and lateral and transmural extent were greater than in patients without this pattern (P<.005, <.001, and <.05, respectively); conversely, infarct size and transmural extent in the inferior wall and in its basal-posterior segment were not significantly different. In patients with a prominent R wave in V₂, infarct size, lateral and transmural extent were not different from patients without this pattern.

Conclusions

Only a prominent R wave in V₁ is a specific sign of large and transmural lateral infarction.Full English text available from:www.revespcardiol.org