Electrocardiographic diagnosis of remote posterior wall myocardial infarction using unipolar posterior lead V9

M. W. Rich, M. Imburgia, T. R. King, K. C. Fischer, K. L. Kovach

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


The accuracy of four electrocardiographic criteria for diagnosing remote posterior myocardial infarction was assessed prospectively in 369 patients undergoing exercise treadmill testing with thallium scintigraphy. Criteria included the following: 1) R-wave width ≥ 0.04 s and R-wave ≥ S-wave in V1; 2) R-wave ≥ S-wave in V2; 3) T-wave voltage in V2 minus V6 ≥ 0.38 mV (T-wave index); 4) Q-wave ≥ 0.04 s in left paraspinal lead V9. Twenty-seven patients (7.3 percent)met thallium criteria for posterior myocardial infarction, defined as a persistent perfusion defect in the posterobase of the left ventricle. Sensitivities for the four criteria ranged from 4 to 56 percent, and specificities ranged from 64 to 99 percent. Posterior paraspinal lead V9 provided the best overall predictive accuracy (94 percent), positive predictive value (58 percent), and ability to differentiate patients with and without posterior myocardial infarction of any single criterion (p < .0001). Combining the T-wave index with lead V9 further enhanced the diagnostic yield: the sensitivity for detecting posterior infarction by at least one of these criteria was 78 percent, and when both criteria were positive, specificity was 98.5 percent. It is concluded that a single, unipolar posterior lead in the V9 position is superior to standard 12-lead electrocardiographic criteria in diagnosing remote posterior myocardial infarction, and that combining V9 with the T-wave index maximizes the diagnostic yield.

Original languageEnglish
Pages (from-to)489-493
Number of pages5
Issue number3
StatePublished - 1989


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