Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
Korean Circ J. 2009 Oct;39(10):418-22. doi: 10.4070/kcj.2009.39.10.418. Epub 2009 Oct 28.
Poor R-wave progression (PRWP) is a common electrocardiographic diagnosis. However, the diagnostic usefulness of PRWP for coronary artery disease (CAD) and the plausible explanation for subjects with normal heart function are unclear.
We included 20,739 subjects who had routine medical examinations and applied the commonly used criteria (R-waves in V3 or V4 </=2 mm) and the Marquette criteria in the current study. Subjects with PRWP by the Marquette criteria, but with no evidence of specific causes, were identified. Healthy age- and gender-matched controls were selected randomly for comparing cardiothoracic ratios.
The commonly used criteria in practice were met by 372 of the 20,739 subjects (1.8%). The Marquette criteria were met by 96 subjects (0.5%), and 82 of who agreed to medical evaluation. Five subjects had known CAD and only one subject was shown to have a silent myocardial infarction by additional testing. Therefore, the positive predictive value of PRWP for CAD was 7.3% (6/82) based on the Marquette criteria. As compared with the control group, the subjects with PRWP had a significantly low cardiothoracic ratio (0.425 vs. 0.445, p<0.05), especially among the male group (0.454 vs. 0.407, p=0.02).
The positive predictive value of PRWP for CAD in the general population is so low that additional tests for diagnosis may be unreasonable. In addition, a low cardiothoracic ratio could be a plausible explanation of PRWP in subjects without any identifiable cause.
低 R 波递增（PRWP）是一种常见的心电图诊断。然而，PRWP 对冠心病（CAD）的诊断价值以及对心功能正常患者的可能解释尚不清楚。
我们纳入了 20739 例接受常规体检的患者，并在本研究中应用了常用标准（V3 或 V4 的 R 波<=2mm）和 Marquette 标准。根据 Marquette 标准诊断为 PRWP，但无明确病因的患者被确定为研究对象。随机选择年龄和性别匹配的健康对照者进行心胸比比较。
在 20739 例患者中，有 372 例（1.8%）符合实践中常用的标准。符合 Marquette 标准的有 96 例（0.5%），其中 82 例同意接受医学评估。5 例患者有明确的 CAD，只有 1 例患者通过额外检查显示为无症状性心肌梗死。因此，根据 Marquette 标准，PRWP 对 CAD 的阳性预测值为 7.3%（6/82）。与对照组相比，PRWP 患者的心胸比明显较低（0.425 比 0.445，p<0.05），尤其是男性患者（0.454 比 0.407，p=0.02）。
PRWP 对普通人群 CAD 的阳性预测值如此之低，以至于额外的诊断检测可能不合理。此外，心胸比低可能是无明确病因的 PRWP 患者的合理解释。
