Precordial R-wave reappearance predicting infarct size and myocardial recovery after acute STEMI

Pathological Q waves may appear on the 12-lead electrocardiogram (ECG) during acute ST-segment elevation myocardial infarction (STEMI) and signify loss of electrical excitation. Anterior wall STEMI often results in loss of R waves in the precordial leads and subsequent appearance of pathological Q waves. Not infrequently, very early loss of R waves may be visible in patients presenting with anterior STEMI and occasionally, these R waves reappear in the first months following the index event. Despite reports in the literature [1–9], the prognostic significance of R-wave reappearance (RWR) in the setting of primary percutaneous coronary intervention (pPCI) remains uncertain. In this report we present two patients with anterior STEMI who underwent uncomplicated pPCI. The follow-up ECGs were indicative of the amount of myocardial recovery after the acute event as shown by cardiovascular magnetic resonance (CMR) imaging. Case report