title: ST-Segment Elevation in the Right Precordial Leads in Patients with Acute Anterior Myocardial Infarction.
abstract: BACKGROUND
  Elevation of ST segment in leads V3R/ V4R, which is commonly encountered in right ventricular myocardial infarction, may also occur in patients with anterior ST elevation myocardial infarction (STEMI). However, the clinical impact of this finding in the setting of anterior myocardial infarction is not well understood.
  
  
  OBJECTIVE
  We aimed to investigate the prognostic value of ST segment elevation in leads V3R/V4R in patients with first acute anterior myocardial infarction.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Right precordial leads V3R/V4R were recorded in 111 patients admitted with first time anterior myocardial infarction. Patients were allocated into two groups based on the presence or absence of ST elevation in leads V3R/V4R. Demographic, biochemical and echocardiographic data, as well as the angiographic information, were recorded. In-hospital and 3 month mortality, and major adverse cardiac events (MACE), death, heart failure and ventricular dysrhythmia were also compared.
  
  
  RESULTS
  ST elevation in lead V3R or V4R was present in 72 out of 111 patients (64.9%). Involvement of the proximal part of the left anterior descending (LAD) artery was not different in the two groups (44.4% of patients with elevation vs. 53.8% of patients without elevation, p=0.22). Post-myocardial infarction complications, mortality and major adverse cardiac events were similar in the two groups. Left ventricular ejection fraction (LVEF) was significantly lower in patients with ST elevation in V3R/V4R (35 %±8 vs. 38 %±8, p=0.02). Twenty three out of 111 patients (20.7%) developed heart failure, which was similar in the two groups [16 (22.2%) of patients with ST elevation vs. 7 (17.9%) of patients without ST elevation, p=0.39].
  
  
  CONCLUSIONS
  Although ST elevation in V3R/V4R can be present in patients with left anterior descending artery occlusion, it does not seem to predict the prognosis. Lower left ventricular ejection fraction in this group may play a role in the long-term prognosis; however, this issue needs further investigation.
authors.affiliation: Department of Cardiology, Tabriz University of Medical Sciences Cardiovascular Research Center, Tabriz, Iran.
authors.forename: Leili
authors.initials: L
authors.lastname: Pourafkari
authors.affiliation: Department of Cardiology, Tabriz University of Medical Sciences Cardiovascular Research Center, Tabriz, Iran.
authors.forename: Saeid
authors.initials: S
authors.lastname: Joudi
authors.affiliation: Department of Cardiology, Tabriz University of Medical Sciences Cardiovascular Research Center, Tabriz, Iran.
authors.forename: Samad
authors.initials: S
authors.lastname: Ghaffari
authors.affiliation: Department of Cardiology, Tabriz University of Medical Sciences Cardiovascular Research Center, Tabriz, Iran.
authors.forename: Arezou
authors.initials: A
authors.lastname: Tajlil
authors.affiliation: Department of Cardiology, Tabriz University of Medical Sciences Cardiovascular Research Center, Tabriz, Iran.
authors.forename: Babak
authors.initials: B
authors.lastname: Kazemi
authors.affiliation: Department of Anesthesiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, New York, USA.
authors.forename: Nader D
authors.initials: ND
authors.lastname: Nader
keywords: Acute anterior myocardial infarction; electrocardiograph; right ventricular dysfunction