Absent right precordial R waves are associated with reduced left ventricular function and poor prognosis in patients with aortic stenosis

Right precordial Q waves can be present in patients with aortic stenosis as well as in those with anterior myocardial infarction. In order to evaluate the relationship of right precordial Q waves to left ventricular function and prognosis in patients with aortic stenosis, we studied 49 such patients with no history of myocardial infarction, by means of ECG, clinical histor y and echocardiography. 15 (31%) patients had Q waves in both V1 and V2 and 34 (69%) did not. There were no differences in age (77+/-9.0 years vs. 78/-9.7), follow-up time(15+/-9.0 months vs. 18+/-10), gender (female:male 8: 7 vs. 15:19), aortic valve gradient on Doppler (70.0+/-20 mmHg vs. 71+/-20) and left ventricular mass (360+/-118 g vs. 320+/-80) between the two group s (all P=NS). Left ventricular shortening fraction (22+/-9.0% vs. 28+/-8.5, P<0.05), ejection fraction (51+/-15% vs. 62+/-12, P<0.01) and circumferent ial fibre shortening (0.8+/-0.3 circ/s vs. 1.0+/-0.3, P<0.0s) were all sign ificantly reduced in patients with right precordial Q waves compared to tho se without. During a mean follow-up of 1.5 years, 9 out of 15 (60%) patient s with right precordial Q waves died compared with only 5 out of 34 (15%) p atients with a normal QRS pattern died (P<0.01). In summary, a right precor dial QS ECG pattern is present in nearly 1/3 patients with aortic stenosis and is associated with impaired left ventricular systolic function and adve rse prognosis. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.