乙酰胆碱试验诱发冠状动脉痉挛时的心电图改变

目的:探讨冠状动脉痉挛发生时的心电图变化规律。方法:64名因胸痛而接受冠状动脉造影的患者,排除具有缺血意义的病变后进行乙酰胆碱试验,术中进行包括胸前V1,3,5在内的9导联心电图记录,比较阳性组和阴性组心电图ST段、T波变化及各种心律失常情况。结果:乙酰胆碱试验阳性组(n=46)中ST段抬高者为19.60%,阴性组(n=18)无ST段抬高(P<0.05);ST段压低者分别为39.1%及11.1%(P<0.05);出现T波高尖者分别为82.6%和16.7%(P<0.001),阳性者ST段变化幅度与冠状动脉痉挛发生时的狭窄程度呈正相关(r=0.62,P=0.042),其中ST段抬高患者的冠状动脉痉挛时狭窄程度均在99% 以上;两组心律失常的发生率无显著差异(P>0.05)。结论:短暂性冠状动脉痉挛不一定伴有ST段抬高,ST段变化与冠状动脉痉挛程度有关,而T波高尖町能比缺血性ST段改变更敏感。试验中的心律失常可能与乙酰胆碱的药理作用有关而与冠状动脉痉挛无关。

Changes of Electrocardiogram During Coronary Artery Spasm Provoked by Acetylcholine Test

Objective: This study was aimed to investigate the features of electrocardiogram during coronary artery spasm. Methods: Sixty-four patients with chest pain but without significant coronary artery stenosis by coronary angiography underwent acetylcholine test. Electrocardiogram was continuously recorded during acetylcholine test. The changes of ST segments, T waves and arrhythmias were investigated and compared between patients with and without coronary artery spasm. Results: ST segment elevation was found in 19.6% of 46 patients with coronary artery spasm but none in the other 18 patients without coronary artery spasm (P < 1. 05). ST segment depression appeared in 39. 1 % and 11.1% of patients with and without coronary artery spasm, respectively (P < 1. 05). Tall peaked T wave was more common in patients with coronary artery spasm (82. 6% ) than in those without spasm (16. 7% , P <0. 001). The amplitude of ST segment elevation or depression was positively related to the severity of coronary artery stenosis induced by spasm. There was no remarkable difference of arrhythmias between two groups. Conclusion: Temporary coronary artery spasm was not necessarily accompanied by ST segment elevation. Changes of ST segment were correlated to severity of coronary artery stenosis induced by spasm. And tall peaked T wave was more sensitive than ST segment in the detection of coronary artery spasm. However, most of arrhythmias during acetylcholine test were induced by acetylcholine itself but not coronary artery spasm.