International journal of cardiology · 2026
Poor R-wave progression fails to detect anterior myocardial fibrosis in MESA.
СтатьяНазвание и аннотация: Перевод в очереди
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de Alencar José Nunes, Morales Paul Alejandro Salvador
Аннотация
BACKGROUND: Poor R-wave progression (PRWP) on the 12‑lead ECG is commonly interpreted as evidence of prior anterior myocardial injury, largely on the basis of small, biased studies from the 1970s-1980s. Whether PRWP identifies anterior-wall fibrosis on modern cardiac magnetic resonance (CMR) is unknown.
METHODS: We analyzed participants from the Multi-Ethnic Study of Atherosclerosis (MESA) Examination 5 with digital ECG and CMR. PRWP was prespecified as RV3 ≤ 3 mm with RV3 > RV2. A historical sensitivity analysis tested the Zema MI criterion (RV3 ≤ 1.5 mm or RI ≤ 4.0 mm). The strict CMR reference required ischemic and transmural scar plus either ≥2 LAD segments or LV scar burden ≥5%; the liberal CMR reference was scar in any LAD segment irrespective of transmurality or burden.
RESULTS: After exclusions, 2950 participants were included; PRWP was present in 163 (5.5%). CMR-defined anterior fibrosis occurred in 21 (0.7%, strict) and 57 (1.9%, liberal). With the strict reference, modern PRWP sensitivity was 0.0% (95% CI 0.0-15.6), specificity 94.4% (94.1-94.8), LR+ 0.00, and LR- 1.06. With the liberal reference, sensitivity was 5.3% (1.1-14.6), specificity 94.4% (94.1-94.8), LR+ 0.95, LR- 1.00. The Zema MI criterion performed similarly: strict-sensitivity 14%, specificity 90%, LR+ 1.48, LR- 0.95; liberal-sensitivity 11%, specificity 90%, LR+ 1.09, LR- 0.99.
CONCLUSIONS: In a large, multiethnic community cohort, isolated PRWP did not detect anterior-wall fibrosis on CMR. PRWP should not be used as a diagnostic marker of anterior myocardial fibrosis without new, rigorously designed accuracy studies.
METHODS: We analyzed participants from the Multi-Ethnic Study of Atherosclerosis (MESA) Examination 5 with digital ECG and CMR. PRWP was prespecified as RV3 ≤ 3 mm with RV3 > RV2. A historical sensitivity analysis tested the Zema MI criterion (RV3 ≤ 1.5 mm or RI ≤ 4.0 mm). The strict CMR reference required ischemic and transmural scar plus either ≥2 LAD segments or LV scar burden ≥5%; the liberal CMR reference was scar in any LAD segment irrespective of transmurality or burden.
RESULTS: After exclusions, 2950 participants were included; PRWP was present in 163 (5.5%). CMR-defined anterior fibrosis occurred in 21 (0.7%, strict) and 57 (1.9%, liberal). With the strict reference, modern PRWP sensitivity was 0.0% (95% CI 0.0-15.6), specificity 94.4% (94.1-94.8), LR+ 0.00, and LR- 1.06. With the liberal reference, sensitivity was 5.3% (1.1-14.6), specificity 94.4% (94.1-94.8), LR+ 0.95, LR- 1.00. The Zema MI criterion performed similarly: strict-sensitivity 14%, specificity 90%, LR+ 1.48, LR- 0.95; liberal-sensitivity 11%, specificity 90%, LR+ 1.09, LR- 0.99.
CONCLUSIONS: In a large, multiethnic community cohort, isolated PRWP did not detect anterior-wall fibrosis on CMR. PRWP should not be used as a diagnostic marker of anterior myocardial fibrosis without new, rigorously designed accuracy studies.