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 history 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 groups (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 circumferential fibre shortening (0.8±0.3 circ/s vs. 1.0±0.3, P<0.0s) were all significantly reduced in patients with right precordial Q waves compared to those without. During a mean follow-up of 1.5 years, 9 out of 15 (60%) patients with right precordial Q waves died compared with only 5 out of 34 (15%) patients with a normal QRS pattern died (P<0.01). In summary, a right precordial QS ECG pattern is present in nearly 1/3 patients with aortic stenosis and is associated with impaired left ventricular systolic function and adverse prognosis.