Two-dimensional echocardiographic assessment of electrocardiographic criteria for right atrial enlargement.
- 1 August 1981
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Cell Metabolism
- Vol. 64 (2), 387-391
- https://doi.org/10.1161/01.cir.64.2.387
Abstract
Right atrial (RA) size was determined with two-dimensional echocardiography using the apical four-chamber view in 45 adult patients with various echocardiographic criteria for RA enlargement and in 25 normal controls. RA size varied from 11.4-24.0 cm2 (mean 16.1 cm2) in controls. RA enlargement (greater than or equal to 25 cm2) was found in only two of 11 patients with P pulmonale (predictive value [PV] = 18%) and one of five with prominent positive P-wave forces in lead V1 (PV = 20%). However, RA enlargement ws found in eight of eight patients with a qR pattern in lead V1 in the absence of clinical indications of coronary artery disease (PV = 100%). RA enlargement was also found in 13 of 28 patients with a total QRS amplitude in lead V1 of 6 mm or less and a threefold or greater ratio of total QRS amplitude in lead V2 relative to that in V1(V2/V1 greater than or equal to 3) (PV = 48%). A V2/V1 ratio of 4 or more detected 11 of 13 patients with RA enlargement, with six false-positive diagnoses (sensitivity = 85%, specificity = 60%, PV = 65%). The combination of total QRS amplitude in V1 of 4 mm or less, together with a V2/V1 ratio of 5 or more, detected six of 11 with RA enlargement, with one false-positive diagnosis (sensitivity = 46%, specificity = 93%, PV = 86%). We conclude that ECG criteria for RA enlargement that primarily use increased P-wave amplitude have a limited PV. The qR pattern in lead V1 appears to be extremely accurate in detecting RA enlargement. ECG criteria in leads V1 and V2 using decreased amplitude in leads V1 and a V2/V1 greater than or equal to 3 are of some value in detecting RA enlargement.This publication has 14 references indexed in Scilit:
- Apex sector echocardiography in evaluation of the right atrium in patients with mitral stenosis and atrial septal defectThe American Journal of Cardiology, 1978
- Task force I: Standardization of terminology and interpretationThe American Journal of Cardiology, 1978
- Predictive value of laboratory testsThe American Journal of Cardiology, 1975
- The electrocardiographic recognition of right atrial abnormality in childrenAmerican Heart Journal, 1971
- Electrocardiographic patterns of right atrial overloading in some congenital heart conditionsThe American Journal of Cardiology, 1968
- Electrocardiographic P wave and atrial weights and volumes.Heart, 1965
- The electrocardiogram in chronic bronchitis with generalized obstructive lung disease: Its relation to ventilatory functionThe American Journal of Cardiology, 1962
- Some views on the significance of qR and QR type complexes in right precordial leads in the absence of myocardial infarctionAmerican Heart Journal, 1952
- MITRAL STENOSISArchives of Internal Medicine, 1938