Author + information
- Received April 2, 1985
- Revision received July 17, 1985
- Accepted July 24, 1985
- Published online December 1, 1985.
- José Lopez-Sendon, MDa,
- Isabel Coma-Canella, MD,
- Soledad Alcasena, MD,
- Jorge Seoane, MD and
- Carlos Gamallo, MD
- ↵aAddress for reprints: José Lopez-Sendon, MD, Unidad Coronaria, Ciudad Sanitaria La Paz, Paseo de la Castellana 261, 28046-Madrid, Spain.
To determine the sensitivity, specificity, predictive value and diagnostic efficiency of electrocardiographic alterations in the diagnosis of acute right ventricular infarction, 43 autopsy patients with acute myocardial infarction and an electrocardiogram including 12 leads plus leads V3R and V4R were studied. Group A included 21 patients with right ventricular infarction, of whom 14 (group AI) had posterior and 7 (group AII) had anterior right ventricular infarction. Group B included 22 patients without right ventricular infarction. Excluding group All patients, the sensitivity of the presence of a Q wave reached 78.6% in lead V4R and decreased in leads V1to V3; its specificity was low in all the leads. The sensitivity of ST segment elevation reached 100% in lead V4R and decreased in leads V1to V3; its specificity was highest (68.2%) in leads V4R and V3R, its negative predictive value was 100% and its diagnostic efficiency was 80.6%. The criterion of ST segment elevation in lead V4R being higher than that in leads V1to V3was less sensitive (78.6%) than ST segment elevation in lead V4R alone, but its specificity reached 100%, its positive predictive value 100% and its diagnostic efficiency 91.7%.
In conclusion, there are no electrocardiographic criteria to identify anterior right ventricular necrosis, but posterior right ventricular necrosis may be identified by the presence of a Q wave or ST segment elevation in the right precordial leads, reaching the highest sensitivity and specificity in lead V4R. The criterion of ST segment elevation in lead V4R being higher than that in leads V1to V3offers the highest specificity and efficiency in the diagnosis.
- Received April 2, 1985.
- Revision received July 17, 1985.
- Accepted July 24, 1985.
- American College of Cardiology Foundation