From the Research
Poor R wave progression is a finding on an electrocardiogram (ECG) where the normal increase in R wave amplitude from lead V1 to V6 across the precordial leads is absent or diminished, and it is associated with an increased risk of sudden cardiac death, cardiac death, and all-cause mortality, as shown in a recent study 1.
Definition and Causes
Poor R wave progression is characterized by the R waves in the anterior precordial leads (V1-V3) remaining small or failing to increase appropriately. This finding can be caused by several conditions, including:
- Anterior myocardial infarction (where scar tissue replaces normal heart muscle)
- Left ventricular hypertrophy
- Right ventricular hypertrophy
- Left bundle branch block
- Incorrect lead placement during ECG recording It may also be a normal variant in some individuals, particularly those with certain body habitus.
Clinical Significance
When poor R wave progression is identified, clinical correlation is necessary to determine its significance, often requiring additional cardiac testing such as echocardiography or cardiac MRI to evaluate for underlying structural heart disease. The physiological basis for this finding relates to the normal electrical activation pattern of the heart, where depolarization typically moves from right to left across the ventricular myocardium, generating progressively larger R waves in the left-sided leads.
Recent Findings
A recent study published in 2022 1 found that poor R wave progression is associated with an increased risk of sudden cardiac death, cardiac death, and all-cause mortality in the general population and in subjects with coronary artery disease. This study highlights the importance of considering poor R wave progression as a potential marker for underlying cardiac disease.
Diagnosis and Evaluation
The diagnosis of poor R wave progression is based on the analysis of the ECG, and it is essential to consider the clinical context and to perform additional testing to determine the underlying cause. The study by 2 found that reversed R wave progression is a highly indicative marker for cardiac disease, particularly ischemic heart disease with left anterior descending artery stenosis.