The Significance of Right-Sided Precordial ECG Leads (V3R and V4R) in Assessing Right Ventricular Dysfunction: A Single Center Cross-Sectional Study

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Noninvasive Electrocardiology Pub Date : 2024-09-09 DOI:10.1111/anec.70006

Reza Khosravi, Hasan Shemirani, Marziyeh Najafi, Zahra Ghaffarinejad, Mahta Arbabi, Marzieh Tajmirriahi

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Abstract

Background

Right ventricular systolic dysfunction is associated with poor prognosis and increased mortality rates. Our objective was to investigate ECG changes in patients with this condition, focusing on the right-sided precordial leads.

Methods

In this cross-sectional study, 60 patients with right ventricular dysfunction were included from April 2020 to April 2021. Cardiac structure and function were assessed using 2D transthoracic echocardiography. Standard 12-lead electrocardiograms and right-sided precordial ECGs (V3R-V4R) were obtained and analyzed for QRS complex configuration, ST-segment elevation, and T-wave morphology.

Results

In our study, the majority were male (70.0%) with a mean age of 58.76 years. The most common initial diagnoses were pulmonary thromboembolism (43.3%), chronic obstructive pulmonary disease (26.7%), and pulmonary hypertension (25.0%). The predominant ECG finding in the right-sided precordial leads (V3R, V4R) was a deep negative T wave (90.0%). Patients with severe right ventricular systolic dysfunction often exhibited a qR pattern (41.2%), whereas those with nonsevere dysfunction showed rS and QS patterns (55.8%). Approximately 41.0% of severe RV dysfunction cases had ST segment depression in the right-sided precordial leads, and 28.0% of patients displayed signs of right atrial abnormality.

Conclusion

The study found that qR, rS, and QS patterns were more prevalent in V3R and V4R leads among patients with severe and nonsevere right ventricular systolic dysfunction. The most common ECG feature observed was deep T-wave inversion in these leads. The study recommends using right-sided precordial leads in all patients with RV systolic dysfunction for early detection and risk stratification.

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右侧心前区心电图导联（V3R 和 V4R）在评估右心室功能障碍中的意义：单中心横断面研究

背景：右心室收缩功能障碍与预后不良和死亡率升高有关。我们的目的是研究这种情况患者的心电图变化，重点是右侧心前区导联：在这项横断面研究中，纳入了 2020 年 4 月至 2021 年 4 月期间的 60 名右心室功能障碍患者。使用二维经胸超声心动图评估心脏结构和功能。获得标准 12 导联心电图和右侧心前区心电图（V3R-V4R），并对 QRS 波群构型、ST 段抬高和 T 波形态进行分析：在我们的研究中，大多数患者为男性（70.0%），平均年龄为 58.76 岁。最常见的初步诊断是肺血栓栓塞症（43.3%）、慢性阻塞性肺病（26.7%）和肺动脉高压（25.0%）。心电图右侧心前导联（V3R、V4R）的主要发现是深负性 T 波（90.0%）。严重右室收缩功能障碍患者通常表现为 qR 模式（41.2%），而非严重功能障碍患者则表现为 rS 和 QS 模式（55.8%）。约 41.0% 的严重 RV 功能障碍病例在右侧心前区导联出现 ST 段压低，28.0% 的患者显示右心房异常：研究发现，在重度和非重度右室收缩功能障碍患者中，V3R 和 V4R 导联的 qR、rS 和 QS 模式更为普遍。在这些导联中观察到的最常见心电图特征是深 T 波倒置。研究建议在所有右室收缩功能障碍患者中使用右侧心前区导联，以进行早期检测和风险分层。

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来源期刊

Annals of Noninvasive Electrocardiology 医学-心血管系统

CiteScore

3.40

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： The ANNALS OF NONINVASIVE ELECTROCARDIOLOGY (A.N.E) is an online only journal that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. ANE is the first journal in an evolving subspecialty that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. The publication includes topics related to 12-lead, exercise and high-resolution electrocardiography, arrhythmias, ischemia, repolarization phenomena, heart rate variability, circadian rhythms, bioengineering technology, signal-averaged ECGs, T-wave alternans and automatic external defibrillation. ANE publishes peer-reviewed articles of interest to clinicians and researchers in the field of noninvasive electrocardiology. Original research, clinical studies, state-of-the-art reviews, case reports, technical notes, and letters to the editors will be published to meet future demands in this field.