Poor evidence for poor R wave progression in coronary disease: A scoping review.

BACKGROUND: Poor R wave progression (PRWP) and reversed R wave progression (RRWP) have long been noted in electrocardiograms as potential indicators of anterior wall fibrosis or chronic coronary artery disease; however, the quantity and quality of evidence supporting these associations warrants closer examination. OBJECTIVE: The aim of this scoping review is to assess the breadth of evidence regarding the diagnostic significance of PRWP and RRWP, explore the extent of research, study populations and methodologies, and the presence of gaps in knowledge regarding these electrocardiographic phenomena and their association with coronary diseases. DESIGN: We conducted a comprehensive search across PubMed, Web of Science, and Scopus, covering literature on PRWP or RRWP in the context of myocardial infarction, ischemia, or fibrosis from any time period and in any language. RESULTS: A total of 20 studies were included in this review, highlighting the severe paucity of data. No high-quality accuracy studies have been identified, and existing research suffers from methodological issues, in particular selection bias. Prevalence and prognostic studies showed significant heterogeneity in terms of definitions and outcomes, which contributes to an alarming risk of bias. CONCLUSIONS: The lack of solid evidence for PRWP and RRWP as diagnostic markers for acute and chronic coronary artery disease necessitates caution in clinical interpretation. Future research should focus on well-designed case-control studies to clarify the diagnostic accuracy of these markers. Until robust evidence is available, the reliance on PRWP/RRWP for diagnosing anterior infarction should be discouraged, reflecting a gap between clinical practice and evidence-based medicine.

Advocating prudent D-dimer testing: constructive perspectives and comments on 'How we manage a high D-dimer'.

Not available.

ST segment and T wave abnormalities: A narrative review.

INTRODUCTION: The electrocardiogram (ECG) is a valuable tool for interpreting ventricular repolarization. This article aims to broaden the diagnostic scope beyond the conventional ischemia-centric approach, integrating an understanding of pathophisiological influences on ST-T wave changes. METHODS: A review was conducted on the physiological underpinnings of ventricular repolarization and the pathophisiological processes that can change ECG patterns. The research encompassed primary repolarization abnormalities due to uniform variations in ventricular action potential, secondary changes from electrical or mechanical alterations, and non-ischemic conditions influencing ST-T segments. RESULTS: Primary T waves are characterized by symmetrical waves with broad bases and variable QT intervals, indicative of direct myocardial action potential modifications due to ischemia, electrolyte imbalances, and channelopathies. Secondary T waves are asymmetric and often unassociated with significant QT interval changes, suggesting depolarization alterations or changes in cardiac geometry and contractility. CONCLUSION: We advocate for a unified ECG analysis, recognizing primary and secondary ST-T changes, and their clinical implications. Our proposed analytical framework enhances the clinician's ability to discern a wide array of cardiac conditions, extending diagnostic accuracy beyond myocardial ischemia.

Poor evidence for poor R wave progression in coronary disease: a scoping review

BACKGROUND Poor R wave progression (PRWP) and reversed R wave progression (RRWP) have long been noted in electrocardiograms as potential indicators of anterior wall fibrosis or chronic coronary artery disease; however, the quantity and quality of evidence supporting these associations warrants closer examination. OBJECTIVE The aim of this scoping review is to assess the breadth of evidence regarding the diagnostic significance of PRWP and RRWP, explore the extent of research, study populations and methodologies, and the presence of gaps in knowledge regarding these electrocardiographic phenomena and their association with coronary diseases. DESIGN We conducted a comprehensive search across PubMed, Web of Science, and Scopus, covering literature on PRWP or RRWP in the context of myocardial infarction, ischemia, or fibrosis from any time period and in any language. RESULTS A total of 20 studies were included in this review, highlighting the severe paucity of data. No high-quality accuracy studies have been identified, and existing research suffers from methodological issues, in particular selection bias. Prevalence and prognostic studies showed significant heterogeneity in terms of definitions and outcomes, which contributes to an alarming risk of bias. CONCLUSIONS The lack of solid evidence for PRWP and RRWP as diagnostic markers for acute and chronic coronary artery disease necessitates caution in clinical interpretation. Future research should focus on well-designed case-control studies to clarify the diagnostic accuracy of these markers. Until robust evidence is available, the reliance on PRWP/RRWP for diagnosing anterior infarction should be discouraged, reflecting a gap between clinical practice and evidence-based medicine.

ST segment and T wave abnormalities: A narrative review

INTRODUCTION: The electrocardiogram (ECG) is a valuable tool for interpreting ventricular repolarization. This article aims to broaden the diagnostic scope beyond the conventional ischemia-centric approach, integrating an understanding of pathophisiological influences on ST-T wave changes. METHODS: A review was conducted on the physiological underpinnings of ventricular repolarization and the pathophisiological processes that can change ECG patterns. The research encompassed primary repolarization abnormalities due to uniform variations in ventricular action potential, secondary changes from electrical or mechanical alterations, and non-ischemic conditions influencing ST-T segments. RESULTS: Primary T waves are characterized by symmetrical waves with broad bases and variable QT intervals, indicative of direct myocardial action potential modifications due to ischemia, electrolyte imbalances, and channelopathies. Secondary T waves are asymmetric and often unassociated with significant QT interval changes, suggesting depolarization alterations or changes in cardiac geometry and contractility. CONCLUSION: We advocate for a unified ECG analysis, recognizing primary and secondary ST-T changes, and their clinical implications. Our proposed analytical framework enhances the clinician's ability to discern a wide array of cardiac conditions, extending diagnostic accuracy beyond myocardial ischemia.