aVR导联对非ST段抬高型急性冠脉综合征冠状动脉病变的预测价值简

目的 通过与冠状动脉造影对比,研究aVR导联ST段改变的特征对非ST段抬高型急性冠脉综合征病变血管的预测价值.方法 分析625例非ST段抬高型急性冠脉综合征患者一般资料、心电图、超声心动图及冠状动脉造影结果.结果 aVR导联无ST段抬高组（n=537）、ST段抬高0.05～0.1 mrn组（n=58）、ST段抬高＞0.1 mm组（n=30）的左心室射血分数分别为53.6％±7.2％、50.2％±6.8％、48.2％±6.4％,3组比较差异有统计学意义（P=0.003）;恶性心律失常（室性心动过速或心室颤动）发生率分别为3.4％、8.6％、13.3％,3组比较差异有统计学意义（P=0.008）;病死率分别为2.2％、5.2％、10％,3组比较差异有统计学意义（P=0.026）;左主干和（或）三支病变的发生率分别为24.8％、37.9％、56.7％,3组比较差异有统计学意义（P＜0.0005）.结论 非ST段抬高型急性冠脉综合征患者出现aVR导联ST段抬高对判断左主干或三支病变有预测价值,应引起高度重视.     

aVR导联对前壁急性心肌梗死相关血管的诊断、预后价值

目的探讨前壁急性心肌梗死（AMI）aVR导联ST段抬高对冠状动脉左主干及左前降支近段病变的诊断及预后价值。方法将61例前壁AMI者的心电图和冠状动脉造影（CAG）及临床资料进行对比分析,根据aVR导联有无ST段变化分为抬高组（A组）及ST段无抬高组（B组）。结果①梗死相关血管为左主干病变的A组及B组分别为5例（19.2%）及1例（2.8%）,两组统计有显著性差异（P〈0.01）。②梗死相关血管为左前降支近段病变的A组及B组分别为20例（76.9%）及5例（14.2%）两组统计有显著性差异（P〈0.01）。③发生心脏事件的A组及B组分别为10例（37.1%）、4例（11.4%）,两组统计有显著性差异（P〈0.01）。结论前壁AMIaVR导联ST段抬高对诊断左主干、左前降支近段病变及预后有很好的预测价值。     

急性左主干病变的心电图分析

目的探讨急性左主干（LMCA）病变的心电图改变。方法分析因急性心肌梗死住院的76例患者（后经冠状动脉造影证实16例为左主干病变,60例为前降支病变）的心电图特点,按病变冠脉分为左主干组和前降支（LAD）组。结果STaVR↑发生率、STaVR↑〉STv1↑的发生率、STaVR↑伴STv1～STv3↑不明显的发生率、STaVR与STaVL均抬高的发生率、STv6↑／STv1↑≥1的发生率,LMCA组明显高于LAD组,二者差异有统计学意义（P〈0．05）。STaVR↑幅度,STaVR↑伴STⅡ、STⅢ、STaVF↓幅度,LMCA组明显高于LAD组,二者差异有统计学意义（P〈0．05）。结论左主干心电图表现为STaVR↑、STaVR↑〉STv1↑、STaVR↑伴STv1-v3↑不明显、STvVR与STaVL均抬高、STv6↑／STv1↑≥1。     

活动平板运动试验诱发aVR导联ST段抬高对左主干或三支病变的预测价值

目的评价活动平板运动试验阳性患者aVR导联ST段(STaVR)抬高对左主干病变或三支病变的预测价值。方法连续选取208例平板运动试验阳性患者,其中71例STaVR抬高≥0.10 mV为STaVR抬高组,137例STaVR抬高0.10 mV为非STaVR抬高组,结合冠状动脉(简称冠脉)造影结果回顾性对比aVR导联抬高幅度、其他导联ST段最大下移幅度、累积ST段下移幅度以及伴随ST段下移导联数、运动时间、Duke评分。分析评价STaVR抬高及STaVR抬高联合运动时间5 min标准预测冠脉病变的灵敏度、特异度、准确度。结果 STaVR抬高组的aVR导联抬高幅度、其他导联ST段最大下移幅度、累积ST段下移幅度以及伴随ST段下移导联数明显高于非STaVR抬高组,运动时间、Duke评分明显低于非STaVR抬高组(P0.01)。STaVR抬高组中三支血管病变发生率(19.7%)明显高于非STaVR抬高组(6.6%),左主干病变发生率亦明显高于非STaVR抬高组(22.5%vs 2.2%,P0.01)。单独STaVR抬高对左主干病变的灵敏度、特异度、准确度分别为84.21%、70.90%、72.12%,对三支病变分别为60.87%、69.19%、68.27%;STaVR抬高且运动时间≤5 min对左主干病变的灵敏度、特异度、准确度分别为63.16%、88.89%、86.54%,对三支病变分别为43.48%、87.57%、82.69%。结论运动试验诱发STaVR抬高可提示左主干或三支病变,结合运动时间可提高特异性。     

QRS时间对非ST段抬高型急性冠状动脉综合征患者左主干或三支病变的预测作用

目的测定非ST段抬高型急性冠脉综合症患者的心电图QRS时间,通过与冠状动脉造影对比,判断其对左主干／三支病变诊断的指导作用。方法对比106例非ST段抬高型急性冠脉综合症患者的体表心电图QRS时间,并与冠状动脉造影结果比较。结果QRS时间和左主干／三支病变具有相关性（OR=904,P〈0．01）,QRS时间／〉90ms预测左主干／三支病变的敏感性为88％,特异性为88％。结论QRS时间增宽可作为非ST段抬高型急性冠脉综合症患者左主干／三支病变的预测因子。     

aVR ST段抬高对急性冠状动脉综合征患者罪犯病变的预测价值

目的 探讨aVR ST段抬高对非ST段抬高性急性冠状动脉综合征患者罪犯病变的预测价值.方法 选择因非ST段抬高性急性冠状动脉综合征入院的患者213例,根据aVR ST段分为抬高组和不抬高组,分析心电图与冠状动脉造影结果及冠状动脉病变范围及狭窄程度（以Gensini积分表示）的关系.结果 抬高组Gensini积分（58.16±43.85）高于不抬高组（23.53±26.80）,差异有统计学意义（P＜0.05）.而ST段抬高的3个亚组（抬高＜0.10mV、0.10～0.15mV、＞0.15mV）Gensini积分差异均无统计学意义（均P ＞0.05）.aVR ST段抬高0.5mV以上对左主干病变的敏感度、特异度、阳性预测值、阴性预测值分别为77.8%、59.5%、34.0%、90.9%;对三支病变分别为82.1%、67.1%、53.4%、89.1%;对左主干合并三支病变分别为88.5%、57.2%、22.3%、97.3%.结论 aVR ST段抬高者病变较重,但抬高幅度并不能预测狭窄程度.aVR ST段抬高是急性冠状动脉综合征左主干和（或）三支病变较强的预测因子.     

aVR导联ST段改变对急性非ST段抬高型心肌梗死相关血管的判定及临床意义

目的探讨体表心电图a VR导联ST段改变对急性非ST段抬高型心肌梗死病人梗死相关血管(IRA)的判定及临床意义。方法回顾性分析230例临床确诊为急性非ST段抬高型心肌梗死病人的临床资料、心电图及冠状动脉造影结果。依据心电图a VR导联ST段变化将病例分为A组(ST抬高组)、B组(ST下移组)和C组(ST无偏移组)。结果冠状动脉造影结果:ST抬高组左主干病变、左前降支病变的发生率明显高于ST下移组和ST无偏移组,差异有统计学意义(P0.05);ST下移组左回旋支病变及右冠状动脉病变的发生率明显高于ST抬高组和ST无偏移组,差异有统计学意义(P0.05);ST抬高组和ST下移组双支病变及三支病变的发生率明显高于ST无偏移组,差异均有统计学意义(P0.05)。a VR导联ST段抬高组、下移组主要不良心血管事件发生率均明显高于ST无偏移组(P0.05)。结论急性非ST段抬高型心肌梗死病人如果伴有a VR导联ST段抬高或下移可能提示梗死相关血管为左主干病变、左前降支病变、左回旋支病变、右冠状动脉病变或严重的多支病变,且住院期间不良心血管事件发生率增高。a VR导联ST段改变对急性非ST段抬高型心肌梗死病人梗死相关血管的判定及临床预后均具有重要的临床指导意义。     

aVR导联ST段抬高急性冠脉综合征患者冠脉造影结果及预后分析

目的 研究aWR导联ST段抬高的急性冠脉综合征患者冠脉造影结果并对其预后进行分析。方法 回顾分析2003～2007年间57例aWR导联ST段抬高急性冠脉综合征患者，参考冠脉造影资料，分析患者冠脉病变部位及预后。结果 57例患者中单支病变19例，其中左主干病变患者6例，前降支近段病变10例，右冠近段病变2例，回旋支近段病变1例；多支病变38例，其中左主干加前降支近段病变9例，前降支加回旋支病变8例，三支病变16例，左主干加三支病变5例。预后分析，57例患者死亡6例，其中3例死于冠脉造影术后12小时以内，急诊CABG5例，择期CABG15例，行介入治疗28例，3例放弃治疗自动出院.结论 aWR导联ST段抬高的急性冠脉综合征患者血管病变往往较重。预后较差，aVR导联sT段抬高对预测罪犯血管、判断病情预后有较好的参考价值。     

aVR导联ST段抬高对急性心肌梗死预后的价值

目的探讨心电图aVR导联ST段抬高对急性前壁心肌梗死患者预后的价值。方法首次入院急性前壁心肌梗死患者57例，对其心电图和冠状动脉造影及临床资料进行对比分析。根据心电图aVR导联ST段变化分为抬高组、无偏移组。结果梗死相关血管为左主干病变的ST段抬高组、ST段无偏移组分别为5例（21．7％）、1例（2．9％），两组统计有显著性差异（p〈0．01）；病变范围为多支病变ST段抬高组、ST段无偏移组分别为10例（43．4％）、8例（23．5％），两组统计有显著性差异（p〈0．05）；发生心脏事件ST段抬高组、ST段无偏移组分别为8例（34.8％）、3例（8．8％），两组有显著性差异（p〈0．01）。结论aVR导联ST段抬高对预测急性前壁心肌梗死患者的预后有重要的价值，应高度重视。     

急性冠脉综合征三支病变患者心电图表现

目的研究急性冠脉综合征(ACS)三支病变患者心电图表现。方法241例冠状动脉(冠脉)造影明确的ACS分成非ST段抬高型急性冠脉综合征(NSTE-ACS)(n=173)与急性ST段抬高型心肌梗死(STEMI)(n=68)两种群体,比较各群体中三支病变与非三支病变患者心电图指标。结果NSTEMI-ACS三支病变与左主干病变患者多表现为V₄~V₆、Ⅰ、Ⅱ导联ST段压低伴随aVR导联ST段抬高的心电图模式。与STEMI非三支病变患者相比,STEMI三支病变患者Ⅰ、aVL、V₆导联ST段抬高数占比较多,且多有aVR导联T波直立与低电压表现;冠脉造影提示STEMI三支病变患者右冠及左回旋支狭窄程度更重。结论NSTEMI-ACS三支病变与左主干病变患者具有相对特定的心电图表现,STEMI三支病变患者心肌梗死部位广泛,易合并侧壁心肌梗死。     

严重冠脉病变的心电图分析

目的分析左主干、前降支近端或三支病变冠心病心绞痛患者的心电图改变。方法13例冠脉造影诊断为左主干、前降支近端或三支病变的患者,对其静息时、心绞痛发作时心电图有无aVR、V1导联的ST段抬高及临床资料进行分析。结果胸痛发作时11例出现了aVR、V1导联典型改变,静息时2例aVR、V1导联改变。结论心电图aVR、V1导联ST段抬高,尤其STaVR〉STV1,V4～V6导联ST段下移,合并Ⅱ、Ⅲ、aVF导联或Ⅰ、Ⅱ导联ST段下移与冠脉左主干、前降支近端严重狭窄及三支病变有良好的相关性。     

急性前壁心肌梗死患者aVR导联ST段变化的临床意义

目的探讨急性前壁心肌梗死患者aVR导联ST段变化的临床意义。方法首次急性前壁心肌梗死患者75例,均经再灌注治疗及冠状动脉造影,依据心电图aVR导联ST段变化将病例分为抬高组、无偏移组和下移组。结果前降支再灌注TIMI分级0~1级在ST段抬高组、无偏移组、下移组分别为15例(78.9%)、31例(91.2%)、21例(95.5%),后两组与ST段抬高组比较有显著差异(P<0.05)。相对2~3级血流也类似情况,ST段抬高组与后两组比较有显著差异(P<0.01),犯罪血管为左主干病变的ST段抬高组、无偏移组、下移组分别为4例(21.1%)、1例(2.9%)、3例(13.6%),有显著差异(P<0.01);病变范围为前降支近端至S1,病变范围为前降支近端至D1,三组无明显差异,多支病变和侧支循环形成2级以上ST段抬高组与无偏移组,下移组与无偏移组均有显著差异(P<0.05);早期临床情况显示ST段抬高组和ST段下移组的血清BNP和cTnI明显高ST段无偏移组(P<0.05);ST段抬高组和下移组行CABG和IABP应用明显高于无偏移组(P<0.01),而左室射血分数(LVEF)无明显差异(P>0.05)。结论急性前壁心肌梗死患者如果aVR导联ST段抬高或下移可能提示有严重的左主干病变,左前降支病变或严重的多支病变,且有大面积的心肌梗死,心肌收缩功能损害明显,应用IABP或急诊CABG比率增高     

aVR导联对急性前壁心肌梗死患者梗死相关血管的预测价值及临床意义

目的 研究aVR导联ST段抬高对急性前壁心肌梗死患者梗死相关血管的预测价值及临床意义.方法 101例首次急性前壁心肌梗死患者根据aVR导联有无ST段抬高分为A组（有ST段抬高）33例和B组（无ST段抬高）68例,对其冠脉造影、心脏彩超结果和临床资料进行比较.结果 ①梗死相关血管为左主干（LM）病变A组9例,B组2例,两组差异有统计学意义（P＜0.01）;梗死相关血管为左前降支（LAD）近端病变A组22例,B组26例,两组差异有统计学意义（P＜0.01）;多支血管病变A组15例,B组16例,两组差异有统计学意义（P＜0.01）.②A组发生心脏事件11例,B组9例,两组差异有统计学意义（P＜0.01）.③A组LVEF值明显低于B组（P＜0.01）.④A组CK-MB峰值明显高于B组（P＜0.01）.结论 aVR导联对急性心肌梗死患者梗死相关血管的判定及预后有重要的临床价值.     

ST segment elevation in lead aVR and coronary artery lesions in patients with acute coronary syndrome

INTRODUCTION: Recently, the prognostic value of ST segment elevation in lead aVR in acute coronary syndrome (ACS) and its relationship with significant stenosis of the left main coronary artery (LMCAS) and three-vessel disease have been highlighted. AIM: Analysis of the relationship between ST segment elevation observed in aVR lead and angiographic severity of coronary artery disease in patients with ACS. METHODS: The study involved 134 patients with ACS, including 54 subjects with ST elevation in aVR (group A) and 80 patients without elevation of ST in the same lead (group B), aged 33-78 years, mean 59.9+/-9.7 years. The severity of coronary artery disease was compared between the two groups. The logistic regression model was used for the analysis of factors affecting ST segment in aVR, as well as LMCAS and three-vessel disease probability. RESULTS: In patients with ST elevation in aVR, three-vessel disease prevalence was two times higher (61.1% vs 35.0%; p <0.01), and LMCAS - three times higher (55.6% vs 17.5%; p <0.000001) than in those without ST elevation in aVR. Factors independently associated with ST elevation in aVR were LMCAS (OR 6.1; 95% CI 2.62-14.23; p <0.00005), ST segment elevation in V1 (OR 3.03; 95% CI 1.34-6.86; p <0.01) and diabetes (OR 2.89; 95% CI 1.17-7.15; p <0.05). The predictors of LMCAS were three-vessel disease and ST elevation in aVR, while the predictors of three-vessel disease were: LMCAS, diabetes, male gender and history of myocardial infarction. CONCLUSIONS: Elevation of the ST segment in aVR in the setting of acute coronary syndrome identifies patients with severe coronary artery disease. Only left main coronary artery disease, however, remains independently associated with ST segment elevation in aVR. Three-vessel disease and the left main coronary artery stenosis equivalent are not independent predictors of ST segment elevation in aVR of standard electrocardiograms recorded in patients with acute coronary syndrome.     

Electrocardiographic localization of the occlusion site in left anterior descending coronary artery in acute anterior myocardial infarction

BACKGROUND: The site of occlusion of left anterior descending coronary artery is important in acute anterior myocardial infarction because, proximal occlusion is associated with less favorable outcome and prognosis. The present study attempted to evaluate the electrocardiographic correlate of the location of the site of the left anterior descending coronary artery occlusion with respect to first septal perforator and/or the first diagonal branch. METHODS AND RESULTS: The study included 50 patients with a first acute anterior myocardial infarction. The electrocardiogram with the most pronounced ST segment deviation before the start of reperfusion therapy was evaluated and correlated with the left anterior descending occlusion site as determined by coronary angiography. ST segment elevation in lead aVR, ST segment depression in lead V5 and ST segment elevation in V1>2.5 mm strongly predicted left anterior descending occlusion proximal to first septal, whereas abnormal Q wave in V4-6 was associated with occlusion distal to first septal. Abnormal Q wave in lead aVL was associated with occlusion proximal to first diagonal, whereas ST depression in lead aVL was suggestive of occlusion distal to first diagonal branch. For both first septal and first diagonal, ST segment depression > or =1 mm in inferior leads strongly predicted proximal left anterior descending artery occlusion, whereas absence of ST segment depression in inferior leads predicted occlusion distal to first septal and first diagonal. All the patients were followed during their in-hospital stay (median of 7 days), during which four patients in the proximal to first septal and first diagonal group and one patient in the distal to first septal and first diagonal group died (p < or = 0.001). CONCLUSIONS: In acute myocardial infarction electrocardiogram is useful to predict the left anterior descending occlusion site in relation to its major side branches and such localization has prognostic significance.     

Utility of Lead aVR for Identifying the Culprit Lesion in Acute Myocardial Infarction

Background: Lead aVR is a neglected, however, potentially useful tool in electrocardiography. Our aim was to evaluate its value in clinical practice, by reviewing existing literature regarding its utility for identifying the culprit lesion in acute myocardial infarction (AMI). Methods: Based on a systematic search strategy, 16 studies were assessed with the intent to pool data; diagnostic test rates were calculated as key results. Results: Five studies investigated if ST‐segment elevation (STE) in aVR is valuable for the diagnosis of left main stem stenosis (LMS) in non–ST‐segment AMI (NSTEMI). The studies were too heterogeneous to pool, but the individual studies all showed that STE in aVR has a high negative predictive value (NPV) for LMS. Six studies evaluated if STE in aVR is valuable for distinguishing proximal from distal lesions in the left anterior descending artery (LAD) in anterior ST‐segment elevation AMI (STEMI). Pooled data showed a sensitivity of 47%, a specificity of 96%, a positive predicative value (PPV) of 91% and a NPV of 69%. Five studies examined if ST‐segment depression (STD) in lead aVR is valuable for discerning lesions in the circumflex artery from those in the right coronary artery in inferior STEMI. Pooled data showed a sensitivity of 37%, a specificity of 86%, a PPV of 42%, and an NPV of 83%. Conclusion: The absence of aVR STE appears to exclude LMS as the underlying cause in NSTEMI; in the context of anterior STEMI, its presence indicates a culprit lesion in the proximal segment of LAD.     

左主干闭塞所致急性心肌梗死的心电图特点

目的分析急性左主干(LM)闭塞的常规心电图(ECG)表现,总结其ECG特点。方法1999年1月至2004年8月,10例急性心肌梗死(AMI)患者经急诊冠状动脉造影证实为急性LM闭塞(LM组),回顾性分析其急诊ECG表现。并选取同时期30例经急诊造影证实为左前降支(LAD)近段闭塞的AMI患者(LAD组),比较两组造影前的急诊ECG表现,以求总结急性LM闭塞的常规ECG特点。结果LM组心率快于LAD组,在心律失常发生率方面两组差异无统计学意义。LM组中9例患者存在aVR导联ST段抬高(≥0·05mV),发生率明显高于LAD组(分别为90%和36·7%,P=0·002),同时LM组aVR导联ST段抬高幅度亦明显大于LAD组。而LM组胸前导联V1-3的ST段抬高程度则明显低于LAD组。aVR导联ST段抬高>0·05mV诊断急性LM闭塞的敏感性为90%,特异性为63·3%。如果同时再满足V1 V2 V3导联ST段抬高程度<0·5mV,其诊断急性LM闭塞的敏感性为90%,特异性达到86·7%。结论aVR导联ST段抬高>0·05mV,同时伴有V1~V3导联ST段抬高不明显、甚至压低是急性LM闭塞区别于LAD闭塞的ECG特点,结合临床表现,分析ECG特点可能有助于造影术前预测此类患者和风险评价。     

Prediction of acute left main coronary artery obstruction by 12-lead electrocardiography. ST segment elevation in lead aVR with less ST segment elevation in lead V(1).

OBJECTIVES: We sought to determine the electrocardiographic (ECG) features associated with acute left main coronary artery (LMCA) obstruction. BACKGROUND: Prediction of LMCA obstruction is important with regard to selecting the appropriate treatment strategy, because acute LMCA obstruction usually causes severe hemodynamic deterioration, resulting in a less favorable prognosis. METHODS: We studied the admission 12-lead ECGs in 16 consecutive patients with acute LMCA obstruction (LMCA group), 46 patients with acute left anterior descending coronary artery (LAD) obstruction (LAD group) and 24 patients with acute right coronary artery (RCA) obstruction (RCA group). RESULTS: Lead aVR ST segment elevation (>0.05 mV) occurred with a significantly higher incidence in the LMCA group (88% [14/16]) than in the LAD (43% [20/46]) or RCA (8% [2/24]) groups. Lead aVR ST segment elevation was significantly higher in the LMCA group (0.16 +/- 0.13 mV) than in the LAD group (0.04 +/- 0.10 mV). Lead V(1) ST segment elevation was lower in the LMCA group (0.00 +/- 0.21 mV) than in the LAD group (0.14 +/- 0.11 mV). The finding of lead aVR ST segment elevation greater than or equal to lead V(1) ST segment elevation distinguished the LMCA group from the LAD group, with 81% sensitivity, 80% specificity and 81% accuracy. A ST segment shift in lead aVR and the inferior leads distinguished the LMCA group from the RCA group. In acute LMCA obstruction, death occurred more frequently in patients with higher ST segment elevation in lead aVR than in those with less severe elevation. CONCLUSIONS: Lead aVR ST segment elevation with less ST segment elevation in lead V(1) is an important predictor of acute LMCA obstruction. In acute LMCA obstruction, lead aVR ST segment elevation also contributes to predicting a patient's clinical outcome.