Abstract P413: Prevalence and Significance of Poor R-Wave Progression on Electrocardiography

Abstract

Background: The QRS pattern on the electrocardiogram (ECG) has an expected progressively increasing amplitude of the R waves in the anterior leads. Poor R wave progression (low R wave amplitude of < 3 mm in V3) is commonly reported, however its clinical significance is unknown. It may be related to underlying cardiac pathology, body habitus, metabolic abnormalities or ECG lead placement errors. Studying the prevalence and significance of these findings in different genders and races will also shed some light on their clinical utility and applicability. Our objective is to assess the epidemiology and clinical significance of “Poor or Abnormal R-Wave Progression” as reported on routine ECGs. Methods: A database of ECGs performed at the University of South Alabama Medical Center ECG database (Intellispace and/or Cerner) was downloaded and compiled into searchable PDF format. ECGs were searched for patients with “Abnormal or Poor R Wave Progression”. Available clinical data on patients with these ECG findings were analyzed and reported as absolute numbers and percentages. Results: The total number of ECG with “Poor R-Wave Progression” were 318. Out of these, 209 (66%) were females and 109 (34%) males; 209 (66%) were black, 105 (33%) were white and 4 (1%) other races. There were 143 (45%) black females, 65 (20%) white females, 66 (21%) black males and 40 (13%) white males. There were 234 (74%) patients < 60 years of age while 85 (26%) were 60 years of age or older. There were 233 (73%) with hypertension. Only 198 (62%) had echocardiograms, with an average ejection fraction (EF) of 52%. Out of these 49 ((25%) had mild to moderate decrease in EF ( > 30 - 50%) while 28 (14%) had severely decreased EF of 30% or less. There were 81 (41%) with wall motion abnormalities concerning for coronary disease, while 95 (48%) had diastolic dysfunction. Discussion: Poor R-wave progression is a commonly reported finding on ECG. It is more prevalent in females, which may be due to improper lead placement or chest size. However, its higher prevalence in blacks may be indicative of higher incidence of heart failure, coronary disease and hypertension. It is more frequent in younger patients who may be more obese, but also carry multiple risk factors for cardiac disease. Poor R wave progression showed strong correlation with any degree of heart failure and with wall motion abnormalities on echocardiogram concerning for coronary disease. Therefore this finding should trigger a diagnostic cascade with echocardiography and/or stress testing, depending on the clinical scenario, in order to identify potentially serious underlying cardiac pathology which may be amenable to therapy.