Poor R-wave Progression Might Indicate Poor Cardiac Outcome

A recent study suggests that Poor R-wave progression (PRWP) in electrocardiogram (ECG) was associated with SCD, cardiac death, and all-cause mortality in the general population. The study findings were published in the journal Heart Rhythm on February 15, 2022.

Poor R-wave progression (PRWP) in the precordial leads is a relatively frequent finding in the standard ECG. However, its prognostic significance remains unclear. Therefore, Dr Linda C. Schröder and her team conducted a study to examine the prognosis associated with PRWP in terms of SCD, cardiac death, and overall mortality in general population subjects with and without CAD.

In this study, the researchers collected 7217 patient data and 12-lead ECGs records from a Finnish general population health examination survey conducted during 1978–1980 with follow-up until 2011. The major endpoints assessed were SCD, cardiac death, and overall mortality. The researchers determined PRWP as R-wave amplitude ≤ 0.3 mV in lead V3 and R-wave amplitude in lead V2 ≤ R-wave amplitude in lead V3.

Key findings of the study:

• Upon analysis, the researchers observed that PRWP occurred in 213 subjects (3.1%).
• During the follow-up period of 24.3 ± 10.4 years, they noted that 3723 patients (54.3%) died.
• They found that the PRWP was associated with older age, higher prevalence of heart failure and CAD, and β-blocker medication.
• Upon multivariate analysis, they found that PRWP was associated with SCD (hazard ratio [HR] 2.13), cardiac death (HR 1.75), and all-cause mortality (HR 1.29).
• In the subgroup with CAD, they observed that the PRWP had a stronger association with cardiac mortality (HR 1.71) than in the subgroup without CAD.
• They further noted that the association with SCD was significant only in the subgroup with CAD (HR 2.62).

The authors concluded, "The main finding of the present study is that PRWP in an ECG is associated with increased mortality and a markedly elevated risk of adverse cardiac events in the general adult population. "

They further added, "The risk of SCD was pronounced in subjects with CAD, indicating that diagnostic measures regarding underlying CAD in subjects with PRWP may be warranted. The future role of PRWP in SCD risk stratification is still to be determined."

For further information:

DOI: https://doi.org/10.1016/j.hrthm.2022.02.010