title: New electrocardiographic diagnostic criteria for the pathologic R waves in leads V1 and V2 of anatomically lateral myocardial infarction.
abstract: OBJECTIVE
  To study the different QRS patterns in leads V1 and V2 in first inferior, lateral, and combined inferolateral myocardial infarction (MI) to recognize which are the ECG criteria that best define the presence of lesions isolated to the anatomically lateral wall of the left ventricle.
  
  
  RESULTS
  We studied consecutive patients with first inferior (15), lateral (9), or inferolateral (21) MI with reference to contrast enhanced cardiac magnetic resonance (CE-CRM). We measured the R-wave amplitude and duration, the R/S ratio, and the T-wave amplitude and polarity in leads V1 and V2. The specificity of the V1 criteria for lateral MI, that is, R/S amplitude ratio 1 or greater and R duration 40 milliseconds or longer, is very high but its sensitivity is low. We defined 2 new criteria, R/S of 0.5 or greater and R amplitude in V1 greater than 3 mm, with each achieving a sensitivity of 73.3% and specificity of 93.3% for lateral/inferolateral MI location.
  
  
  CONCLUSIONS
  (1) New ECG criteria for lateral MI (R/S ratio in V1 > or =0.5 and R amplitude in V1 >3 mm) present very high specificity and lower but very acceptable sensitivity for lateral MI. (2) New criteria based on R waves in V2 or T waves in V1 to V2 do not discriminate between inferior and lateral MI. (3) The classical criteria (R/S amplitude ratio > or =1 and R duration > or =40 ms in V1) attain very high specificity but much lower sensitivity than the new criteria.
authors: Cardiology Service, Hospital Santa Creu i Sant Pau-ICCC, Barcelona, Spain. abayesluna@santpau.es
authors: Antoni Bayés
authors: AB
authors: de Luna
authors: Juan
authors: J
authors: Cino
authors: Diego
authors: D
authors: Goldwasser
authors: Anna
authors: A
authors: Kotzeva
authors: Roberto
authors: R
authors: Elosua
authors: Francesc
authors: F
authors: Carreras
authors: Sandra
authors: S
authors: Pujadas
authors: Xavier
authors: X
authors: Garcia-Moll
authors: Miquel
authors: M
authors: Santaló
authors: Miquel
authors: M
authors: Fiol
authors: Antoni
authors: A
authors: Bayés-Genís
authors: Guillem
authors: G
authors: Pons-Lladó
authors: Juan
authors: J
authors: Cinca
mesh_terms: D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity