Electrocardiographic poor R-wave progression. Correlation with postmortem findings.

Electrocardiographic criteria have been derived from vectorcardiographic and angiographic correlation which allow division of patients with electrocardiographic "poor R-wave progression" or "reversed R-wave progression" into the following four etiologic groups: (1) anterior myocardial infarction; (2) left ventricular hypertrophy; (3) type-C right ventricular hypertrophy; and (4) the normal variant. The sensitivity, specificity, and predictive value of this approach to the electrocardiogram with poor or reversed R-wave progression were studied in a series of 33 patients examined at autopsy. Using the scheme and criteria outlined, 85 percent (11/13) of the pathologic anterior myocardial infarctions were correctly diagnosed. The electrocardiographic criteria correctly identified 75 percent (15) of 20 patients with poor or reversed R-wave progression without postmortem evidence of myocardial infarction, with only 12 percent (2/17) predictive error. The relative risk of autopsy-documented anterior myocardial infarction in patients meeting the specified electrocardiographic criteria was six times that of other patients with poor or reversed R-wave progression.