July 1, 1982
View Full PaperA Specific ECG Triad Associated with Congestive Heart Failure
Key Result
A specific ECG triad of high precordial QRS voltage, low limb lead voltage, and poor precordial R wave progression had a 91% predictive value for current or previous left ventricular failure.
Study Design
Type
Observational (n=2,157)
Structured PICO
Is a specific ECG triad associated with the presence of congestive heart failure?
P
Population
A retrospective study of 27 patients with cardiomyopathy and 130 controls, plus a prospective survey of 2000 consecutive patients, evaluating a novel ECG triad for congestive heart failure.
E
Exposure
Presence of a specific ECG triad (High precordial QRS voltage, relatively low limb lead voltage, poor precordial R wave progression)
C
Comparator
Absence of the ECG triad / Control groups without heart failure
O
Outcome
Diagnosis of current or previous left ventricular failuresurrogate
A specific ECG triad consisting of high precordial QRS voltage, low limb lead voltage, and poor precordial R wave progression is highly predictive of congestive heart failure.
Abstract
No specific ECG sign of congestive heart failure has been described. This report deiineales a new triad consisting of 1) High precordial QRS voltage (SV1 or SV2 + RV5 or RV6 ≥ 3.5 mV); 2) Relatively low limb lead voltage (total QRS amplitude ≤ 0.8 m V in the limb leads); 3) Poor precordial R wave progression (R/S ratio < 3 in V4). In a retrospective study of 27 patients with idiopathic congestive cardiomyopathy, this triad was noted on at least one occasion in 19 cases (70%). This pattern was not noted at all in a control group of 100 adults without heart disease or in a separate control group of 30 preoperative patients with left venlricular hypertrophy due to aortic valve disease and normal left ventricular function. Three of these patients subsequently developed this pattern as a false positive sign immediately following aortic valve replacement. In a prospective survey of ECGs from 2000 consecutive patients, this triad appeared in 32 cases (1.6% prevalence). Definite evidence of current or previous left ventricular failure, usually severe, was noted in 29 of these cases (91% predictive valuel as evidenced by pulmonary venous hypertension or pulmonary edema on chest x‐ray, left ventricular ejection fraction ≤ 40%, or echocardiographic left ventricular end‐diastolic dimension ≥ 6.0 cm. The pathophysiology of this highly specific ECG triad probably relates to a number of mechanical and vectorial factors associated with congestive heart failure of a variety of etiologies. Left ventricular enlargement causes increased precordial voltage. In addition, the horizontal plane vector shifts posteriorly, orthogonal to the frontal plane, causing poor R wave progression and low limb lead voltage. Finally, increased extracellular fluid may preferentially attenuate QRS voltage in the more distal (limb) leads. (PAGE, Vol. 5, July‐August, 1982)