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Circulation, Vol 77, 1283-1290, Copyright © 1988 by American Heart Association

ARTICLES

Diagnosis of right ventricular involvement in chronic inferior myocardial infarction by means of body surface QRS changes

M Yamaki, K Ikeda, K Honma, N Kiriyama, I Tono-oka, K Tsuiki and S Yasui
First Department of Internal Medicine, Yamagata University School of Medicine, Japan.

ST segment elevation in right precordial leads is thought to be good predictor of right ventricular involvement in patients with acute inferior myocardial infarction. This view, however, is rapidly disappearing. Therefore, using QRS changes in body surface potential maps in the chronic phase, we have attempted to differentiate patients with or without right ventricular involvement. Thirty patients with chronic inferior myocardial infarction (2 or more months after onset) were studied, in whom 87 unipolar ECGs and right ventriculograms were recorded. The patients were then divided into three groups depending on the locations of their abnormal QRS potentials (-2SD area) exceeding the normal range (mean -2SD). In group A, the -2SD area was located predominantly on the right inferior chest, in group B on the left inferior chest, and in group N on both the right and left inferior chests equally. The results showed that group A had a lower right ventricular ejection fraction (RVEF) compared with group B (A, 40 +/- 7%; B, 53 +/- 10%; p less than .001), while there was no difference in left ventricular ejection fraction between the two groups (49 +/- 11% and 49 +/- 11%, respectively). Moreover, right ventricular asynergy occurred in 14 of the 18 patients (78%) of group A but in only one of the 10 patients (10%) of group B. Group N was presumed to be intermediate between groups A and B.(ABSTRACT TRUNCATED AT 250 WORDS)