Author + information
- Received March 21, 1983
- Revision received June 20, 1983
- Accepted June 22, 1983
- Published online December 1, 1983.
- Nicholas L. DePace, MD,
- Jay Colby, BS,
- A-Hamid Hakki, MD, FACC,
- Bruno Manno, MD,
- Leonard N. Horowitz, MD, FACC and
- Abdulmassih S. Iskandrian, MD, FACC*
- ↵*Address for reprints: Abdulmassih S. Iskandrian, MD, Likoff Cardiovascular Institute, Hahnemann University and Hospital, 230 North Broad Street, Philadelphia, Pennsylvania 19102.
A definite diagnosis of anterior myocardial infarction is often difficult to make in patients when a pattern of poor R wave progression in the precordial leads is present on the electrocardiogram. The purpose of this study was to determine whether a mathematical model could be devised to identify patients with anterior infarction among 102 consecutive patients with poor R wave progression. Each patient underwent exercise testing with thallium scanning. The diagnosis of anterior infarction was established in 20 (20%) of the 102 patients by the presence of fixed thallium-201 perfusion defects in the anterior wall or septum, or both. With the use of a multivariate stepwise discriminant analysis of clinical and electrocardiographic variables, five variables (sex, ST-T changes, S wave amplitude in leads V2and V3and the sum of the R wave amplitude in leads V3and V4) that were statistically significant by univariate analysis were selected by the model to identify patients with anterior infarction (sensitivity 85%, specificity 71%). The discriminant model was subsequently applied prospectively to an additional 21 patients with poor R wave progression and provided a sensitivity of 85% and a specificity of 88%.
Thus, anterior infarction (fixed thallium-201 defects in the anteroseptal segments) was present in 20% of patients with poor R wave progression in the precordial leads; and a mathematical model can be used to identify a subset of patients with anterior infarction in a group of patients with poor R wave progression.
- Received March 21, 1983.
- Revision received June 20, 1983.
- Accepted June 22, 1983.
- American College of Cardiology Foundation