The Diagnostic Utility of Precordial R Wave Progression in theClinical Electrocardiograms of Male Subjects
Bibliographic record
Abstract
Poor R wave progression is used as an interpretative term in clinical electrocardiography to infer that the precordial R wave voltage is abnormal, most often secondary to previous ischemic damage. Specific definition and predictive value of the term are, however, lacking for most clinical settings. We developed several definitions of poor R wave progression from V(1) to V(6) peak R wave measurements in 50 normal subjects and evaluated them as screening criteria for left ventricular asynergy and history of infarction in a consecutive series of 50 male patients undergoing invasive cardiac investigation, principally for chest pain. In normals, peak R values and adjacent interlead differences tended to be greater in males; on average, however, there was a progressive increase from V(1) to V(4) and a progressive decrease from V(4) to V(6) in both males and females. All normals had a positive delta V(1) V(2), but 9 had negative delta V(2) V(3) and 2 others, negative delta V(3) V(4). Based on the normal distributions, the test criteria of poor R wave progression were selected to avoid oversensitivity and to encompass both adjacent lead and panprecordial R wave progression. Positive tests were defined as delta; (1) V(1) V(2) ≤ s 0; (2) V(1) V(2) ≤ normal male mean -1 SD; (3) V(3) V(4) ≤ 0; (4) V(3) V(4) ≤ normal male mean -1 SD; (5) V(1) V(4) ≤ normal male mean 1 SD; (6) V(1) V(4) ≤ normal male mean -2 SD. Overall, the defined R wave criteria were insensitive and had poor negative predictive value for wall asynergy and infarction history. However, delta R V(1) V(2) ≤ 0 and delta R V(3) V(4) ≤ 0 were ≥ 70% positively predictive for these standard clinical variables. In comparison, abnormal Q waves in any lead were 94% predictive for the presence of both variables, although they, too, were relatively insensitive (47% for asynergy; 64% for history of infarction) and had low negative predictive values. Thus, although no single 12-lead electrocardiographic criterion appears ideal as a screening test for ischemic left ventricular injury in male cardiac patients, abnormal Q waves have very high predictive value. With the exception of delta R V(1) V(2) ≤ 0 or delta R V(3) V(4) ≤ 0, the term ‘poor R wave progression’ is unwarranted for routine clinical use.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".