Goldberger's electrocardiographic triad in patients with echocardiographic severe left ventricular dysfunction.

In 1982, Goldberger described an electrocardiographic triad (SV1 or SV2 + RV5 or RV6 ≥ 3.5 mV, total QRS amplitude in each of the limb leads ≤ 0.8 mV, and R/S ratio < 1 in lead V4) that was 70% sensitive and > 90% specific for detecting severe left ventricular (LV) dysfunction. To confirm his sensitivity results, in 51 consecutive patients (36 men) aged 28 to 84 years (mean 56) with LV ejection fractions ≤ 20%, the electrocardiographic triad was sought in the electrocardiogram (ECG) recorded closest in time to the echocardiographic study. All 51 patients had systemic arterial hypertension. Evidence of ischemia was present in 7 and absent in 38, and in 6 patients, ischemic status was unknown. In 49 patients, New York Heart Association functional class was available: class II in 8, class III in 32, and class IV in 9. LV ejection fractions ranged from 4% to 20% (mean 14%), and LV internal end-diastolic diameters ranged from 5.7 to 8.6 cm (mean 6.6). Left atrial anteroposterior diameters ranged from 2.9 to 6.1 cm (mean 4.7) and were ≥ 4.0 cm in 47 of the 51 patients. The right ventricular cavity was enlarged in 22 patients. SV1 or SV2 + RV5 or RV6 was ≥ 3.5 mV in 29 of the 51 ECGs; total QRS amplitude was ≤ 0.8 mV in each of leads I, II, and III in 10; and the R/S ratio was < 1 in lead V4 in 37. Only 1 of the 51 ECGs met all 3 criteria. In contrast to Goldberger's finding of the triad to be 70% sensitive for severe LV dysfunction, in this study, the triad was found to be only 2% sensitive. The difference is likely due to his patients' having idiopathic dilated cardiomyopathy, whereas those in this study had hypertensive cardiomyopathy with or without ischemia. Also, in this study, 1 specific ECG was used for each patient, whereas Goldberger reviewed all of the patients' ECGs looking for the triad. In conclusion, Goldberger's triad is a sensitive or insensitive marker for severe LV dysfunction depending on the patient population and the number of ECGs reviewed.

Stenting of atherosclerotic stenoses in anomalously arising coronary arteries.

This description of five cases brings to 37 the total number of reported patients in whom atherosclerotic lesions of anomalously arising coronary arteries have been stented. One-half of these have been right coronary arteries arising from the left sinus of Valsalva, followed in frequency by branches of single coronary arteries arising from solitary aortic ostia and left circumflex arteries arising from the right sinus of Valsalva or from the proximal portion of the right coronary artery. Proper guide-catheter selection, essential for successful stenting, usually matches the guide's configuration to the sinus of Valsalva from which the anomalous artery originates rather than to the final distribution of the coronary artery.