Key result
Precordial mapping ECG scoring identifies anterior MI in poor R wave progression with ~93% specificity.
Why the study?
Poor R wave progression (PRWP) is observed in various cardiac conditions and normal individuals, but differentiation of its causes using precordial mapping ECG was needed.
Cross-Sectional (n=160)
No
May aid PRWP cause differentiation in select cases; leaves open whether mapping improves diagnostic accuracy or outcomes over standard ECG.
Poor R wave progression (PRWP)は陳旧性前壁中隔心筋梗塞,左室肥大,ある種の右室肥大および心疾患のない正常人において認められる心電図所見である.本研究は前胸壁マッピング心電図を用いて, PRWPの原因疾患を鑑別することを目的とした,標準12誘導心電図でPRWPの基準(V1V2V3誘導のr波が0.3mV以下)を満足する160例を対象とした.対象症例を4群(前壁中隔心筋梗塞61例,左室肥大41例,肺疾患18例,正常40例)に分類した.全例に36誘導の前胸壁マッピング心電図を記録し,枝分かれ方式でそれぞれの群を比較検討した.各群をV1V2V3誘導のQRS波形によつて6型に分類し,各型毎に心筋梗塞と他の3群とを比較した. I型(QS・QS・QS), II型(QS・QS・rS), III型(rS・QS・QS), IV型(QS・rS・rS), V型(rS・rS・QS), VI型(rS・rS・rS).一方で,初期r波の波高値によつて, r=0mV (4点)から0.lmV毎にr>0.3mV (0点)までの5段階の得点を付け,得点法とした.この得点法およびQSパターンの総数が,前壁中隔心筋梗塞を鑑別する有用な要素であつた.他にQRS波の波高値, R/S比,陰性T波の位置が有用な鑑別要素となつた.これらの要素を組み合わせることにより,各群が下記の診断率(sensitivity, specificity)で鑑別された.前壁中隔心筋梗塞I～V型(100%, 100%), VI型(87.5%, 92.6%),左室肥大(94.8%, 92.7%),肺疾患(77.8%, 95.1%).
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Chiaki Shirato (1983) conducted a cross-sectional in Poor R wave progression (PRWP) (n=160). 36-lead precordial mapping electrocardiography vs. Standard 12-lead ECG was evaluated on Diagnostic sensitivity and specificity for differentiating underlying causes of PRWP (e.g., anterior myocardial infarction). Precordial mapping electrocardiography using a scoring system and QS pattern count accurately differentiated causes of poor R wave progression, achieving 87.5% sensitivity and 92.6% specificity for anterior myocardial infarction in Type VI cases.
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