Electrocardiographic poor R wave progression. II: correlation with angiography.

Forty patients with "poor R wave progression" (PRWP) or "reversed R wave progression" (RRWP) on the electrocardiogram (ECG) who underwent coronary arteriography and left ventriculography within one month of electrocardiographic recording were analyzed. Patients were randomly selected from a population of catheterization proven predominant mitral stenosis with elevated right ventricular pressures (presumed right ventricular hypertrophy), predominant aortic stenosis with increased left ventricular mass (left ventricular hypertrophy) and anterior myocardial infarction (AMI). Application of criteria previously derived from vectorcardiographic (VCG) correlative data, as well as inclusion of right precordial lead repolarization abnormalities, correctly diagnosed 85% (11/13) of angiographic AMIs. It is clinically useful to note that 56% (15/27) of patients with either PRWP or RRWP who did not exhibit angiographic AMI could be identified by 12 lead ECG with only 12% (2/17) false negative AMIs. In comparison with Q wave anterior myocardial infarctions, those with only PRWP or RRWP exhibited a trend toward a less severe degree of contraction abnormality on contrast ventriculography.