运动试验阳性患者aVR及V1导联ST段变化对左主干病变的预测价值

Objective To evaluate the value of lead aVR and V1 on the exercise electrocardiogram for the detection of left main coronary artery disease (LMCAS) in patients with the positive EET result ( Duke scores ≤ - 11 ). Methods Ninty-six patients with Duke score ≤ - 11 were retrospectively screened for presence of ST-segment elevation in lead aVR and lead V1. Coronary arteriography (CAG) results were compared among different groups. Results Twenty-eight out of 96 were diagnosed as LMCAS. 24 out of 60 with ST-segment elevation in lead aVR and 26 out of 34 with ST-segment elevation in lead aVR and V1 ( STaVR/STV1＞ 1 )were found to have LMCAS. Isolated exercise-induced ST elevation in lead aVR had a sensitivity of 85. 5, a specificity of 47. 1% and an accuracy of 62. 5% in predicting LMCAS; ST-segment elevation in lead aVR and V1 ( STaVR/STV1 ＞ 1 ) had a sensitivity of 82. 1% ,a specificity of 83. 8% and an accuracy of 83.3% in predicting LMCAS. Conclusion ST-segment elevation in lead aVR and V1(STaVR/STV1 ＞ 1) criteria has a high value in predicting LMCAS.     

运动试验阳性患者aVR及V1导联ST段变化对左主干病变的预测价值

Objective To evaluate the value of lead aVR and V1 on the exercise electrocardiogram for the detection of left main coronary artery disease (LMCAS) in patients with the positive EET result ( Duke scores ≤ - 11 ). Methods Ninty-six patients with Duke score ≤ - 11 were retrospectively screened for presence of ST-segment elevation in lead aVR and lead V1. Coronary arteriography (CAG) results were compared among different groups. Results Twenty-eight out of 96 were diagnosed as LMCAS. 24 out of 60 with ST-segment elevation in lead aVR and 26 out of 34 with ST-segment elevation in lead aVR and V1 ( STaVR/STV1＞ 1 )were found to have LMCAS. Isolated exercise-induced ST elevation in lead aVR had a sensitivity of 85. 5, a specificity of 47. 1% and an accuracy of 62. 5% in predicting LMCAS; ST-segment elevation in lead aVR and V1 ( STaVR/STV1 ＞ 1 ) had a sensitivity of 82. 1% ,a specificity of 83. 8% and an accuracy of 83.3% in predicting LMCAS. Conclusion ST-segment elevation in lead aVR and V1(STaVR/STV1 ＞ 1) criteria has a high value in predicting LMCAS.     

平板运动试验aVR导联ST段抬高对冠状动脉左主干病变的诊断价值

目的探讨平板运动试验aVR导联ST段抬高对冠状动脉左主干病变及前降支近段病变诊断价值。方法选取18例平板运动试验阳性并伴aVR导联ST段抬高者,2周内行冠状动脉造影(CAG),以冠状动脉内径狭窄≥50%者为CAG阳性。结果左主干病变13例,前降支近段病变3例,右冠状动脉中段狭窄1例,冠状动脉造影阴性1例。平板运动试验阳性并伴aVR导联ST段抬高对左主干病变的阳性预测值为72.22%(13/18);对冠状动脉左主干及前降支近段病变的预测值为88.89%(16/18)。结论平板运动试验阳性并aVR导联ST抬高≥0.1mv对诊断冠状动脉左主干及前降支近段病变有较高的阳性预测价值。     

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。     

心电图表现为aVR导联下斜型ST段抬高的急性左主干病变1例

急性左主干病变病情严重,危险程度等同于急性ST段抬高型心肌梗死,需尽快行冠状动脉介入治疗.本文报道1例急性左主干病变的急性心肌梗死病例,心电图表现为aVR导联ST段下斜型抬高,Ⅰ、aVL导联ST段弓背向下抬高,Ⅱ、Ⅲ、aVF、V4—V6导联ST段压低,并探讨了aVR导联ST段抬高对预测左主干病变的意义.     

aVR ST段抬高对左主干及前降支近端病变的预测价值

左主干狭窄是冠心病中的严重病变,易发生猝死。当前冠状动脉造影或64排螺旋CT可明确诊断。本文通过分析冠状动脉造影结果及与之相对应的心电图中aVRST段抬高情况,旨在评价aVRST段抬高对左主干及前降支近端严重病变的预测价值,为制定及时正确安全的治疗方案提供帮助。     

心电图aVR导联ST段变化的临床意义

心电图aVR导联ST段的抬高或压低，往往提示病人存在严重的冠状动脉左主干病变、前降支近段病变或三支病变，病人的预后较差，需要及时的干预治疗。     

左主干病变的心电图表现及对aVR导联ST段改变的再认识

左主干病变是冠心病的严重类型,无论慢性狭窄或急性闭塞,均对患者生命均构成严重威胁。左主干病变是指冠状动脉造影发现左主干直径狭窄≥50％时,产生显著的血流动力学影响的病变。但某些狭窄程度〈50％的不稳定斑块破裂后血栓形成可造成左主干急性闭塞,也属于左主干病变。     

aVR 导联对急性心肌梗死中左主干病变的诊断意义

目的：通过分析急性心肌梗死患者12导联心电图,探讨心电图对左主干病变的诊断意义。方法对急性心肌梗死并行冠脉造影术的4914例患者进行分层随机抽样,根据造影结果,将样本分为左主干病变组及非左主干病变组。记录两组一般临床资料,盲法测量两组心电图,对比两组得出预测左主干病变的指标。结果二元 logistic 回归分析表明,aVR 导联 ST 段抬高≥0．05 mV（OR：8．160,P ＜0．05）是左主干病变的独立预测因子。联合 aVR 导联ST 段抬高≥0．05 mV、V4～V6导联 ST 段压低、≥5个导联 ST 段压低、aVF 导联低电压、QRS 波群时限＞100 ms 这5个无创性指标,可将确诊左主干病变的概率从25．19％提高到69．24％。5个心电图指标的阳性预测值分别为52．63％、32．73％、26．39％、16．22％和22．22％。结论心电图对急性心肌梗死中左主干病变的预测是可行的。aVR 导联 ST 段抬高≥0．05 mV 是预测左主干病变良好的心电图指标,联合多指标可提高心电图对左主干病变的诊断价值。     

aVR 导联 ST 段抬高对冠脉左主干和／或3支血管病变的诊断价值

严重的冠脉病变包括冠脉左主干（left main coronary artery,LMCA）急性完全闭塞、次全闭塞以及3支血管病变（3-vessel disease,3-vd）。尽管 LMCA 急性完全闭塞患者能生存到达医院者很少,但 aVR 导联 ST 段抬高对其诊断的特异性和准确率均超过80％。对 LMCA 急性次全闭塞及3-vd 患者,aVR 导联 ST 段抬高的诊断价值高于心电图的任何其他单一或多个导联。aVR 导联 ST 段抬高幅度越大、持续时间越长,患者的病情就越重。本文对 aVR 导联 ST段抬高的诊断标准、电生理机制及国外研究进展进行综述。     

QRS波宽度及aVR导联ST段抬高对NSTE-ACS左主干或三支病变的预测作用

目的研究非ST段抬高型急性冠脉综合征(NSTE-ACS)患者心电图的QRS波宽度及aVR导联抬高幅度对冠状动脉左主干/三支病变的诊断价值。方法分析106例NSTE-ACS患者的体表心电图QRS波宽度及aVR导联ST段抬高幅度,通过与冠状动脉造影结果对比,研究其对诊断左主干/三支病变的敏感性、特异性和相关性。结果 QRS波宽度及aVR导联ST段抬高是左主干/三支病变的独立预测因子,OR值分别为9.04(95%CI,4.88～16.7)、7.10(95%CI,4.91～76.2);QRS间期≥90ms和aVR导联ST段抬高≥0.5mm预测左主干/三支病变的敏感性及特异性分别为88%、76%及88%、86%。结论 QRS波增宽及aVR导联ST段抬高是NSTE-ACS患者左主干/三支病变较为灵敏的预测因子。     

Immediate and long-term outcomes of stent implantation for unprotected left main coronary artery disease

Left main coronary artery (LMCA) disease is now uniformly treated with coronary artery bypass grafting (CABG). However, some patients with LMCA disease do not receive CABG because of high operative risks. The advent of stent implantation has permitted a non-operative improvement in myocardial blood flow in many patients with single- and multi-vessel coronary artery disease. However, the outcomes of stent implantation for unprotected LMCA disease are still unclear. Stent implantation was performed for unprotected LMCA disease in 13 patients; eight patients had high operative risk and five patients had refused CABG. The primary success rate was 100% (13/13 patients). One patient (8%) developed a non-Q-wave myocardial infarction after LMCA stenting. Repeat angiography was obtained in five patients (38%) with recurrent angina, and three patients (23%) received repeated percutaneous transluminal coronary angioplasty (PTCA) for LMCA restenosis. In the follow-up period of 18±3 months, 12 patients (92%) remained in satisfactory condition with no further need for surgical intervention. One patient (8%) ultimately required CABG, and she died after CABG at 3 months after LMCA stenting. In conclusion, although CABG remains the standard treatment for LMCA disease, the present study demonstrates that stent implantation is a safe and clinically beneficial revascularization procedure for unprotected LMCA disease in patients who have high operative risk as well as those who refuse CABG.     

aVR、V1导联心电图对左主干及前降支近端明显狭窄的诊断价值

目的探讨aVR、V1导联对冠状动脉左主干及前降支近端狭窄诊断的阳性预测价值。方法对比分析120例冠造结果为左主干病变患者典型aVR、V1导联心电图改变的几率，对比分析120例心电图有典型变化患者的冠脉造影结果。结果①有68例（占56．7％，68／120，）的左主干病变患者出现了典型的aVR、V1导联心电图表现，即典型“左主干”心电图对左主干病变诊断的敏感性为56．7％；②有31例（占37.3％，31／83）典型aVR、V1导联心电图患者冠造结果为左主干病变，有81例（占97．6％，81／83）的典型aVR、V1导联心电图患者冠造结果为左主干及前降支病变，37例患者未检查冠造，典型“左主干”心电图对左主干病变的阳性预测价值为37.3％．而对左主干及／或前降支近段狭窄病变的预测价值为97．6％，二者的差异有显著性（p〈0．001）。结论心电图出现aVR、V1导联ST抬高〉1mm，且aVR导联ST段抬高〉V1导联，V4-6导联ST段下移≥2mm，Ⅱ、Ⅲ、aVF导联ST段下移≥1mm对诊断左主干或前降支近段明显狭窄有很好的阳性预测价值。     

Clinical presentation and prognosis of left main coronary artery disease in the 1980s

Clinical presentation and course were studied in 127 consecutive patients with angiographically proven left main coronary artery disease. Mean age was 62 (37-79) years. Thirteen patients (10%) had no history of chest pain, seven (5%) had atypical chest pain, and the remaining 107 (85%) typical angina pectoris. Eighty-two patients (65%) had unstable angina, 73 had suffered a myocardial infarction (MI) in the past, and 50 (68%) had post MI angina pectoris. The electrocardiogram was analysed in 102/125 patients during an episode of chest pain and also when they were without chest pain. Outside an episode of chest pain the ST segment was normal in 42 patients (32%), the T wave was normal in 50 patients (38%) and both the ST and T were normal in 33 patients (25%). During chest pain all patients had an abnormal ECG, the most frequent pattern being ST segment depression in leads V3, V4 and V5 (with maximal depression in V4), and ST segment elevation in leads V1 and aVR. The average number of leads with ST-T abnormalities was 6.4. A symptom-limited exercise test on a treadmill with 12-lead ECG monitoring was performed in 89 patients. The exercise test was abnormal in 88 patients (99%), most of whom (74 patients) were already in the first or second stage of the Bruce protocol. The most frequently observed abnormality was ST segment depression of 2 mm or more in leads V4, V5, and V6, and ST segment elevation in leads V1 and aVR. The systolic blood pressure during exercise fell or remained at the same level in 38 patients (43%).(ABSTRACT TRUNCATED AT 250 WORDS)     

冠状动脉左主干病变的治疗策略

冠状动脉(冠脉)左主干病变首选冠脉搭桥手术(CABG),尽可能选择不停跳CABG。急诊CABG风险较高,手术适应证①严重的左主干病变(>75%),尤其"无保护"左主干病变;②左主干病变>50%,并(或)有3支病变,出现严重的危及生命的室性心律失常;③左主干病变伴有急性冠脉综合征。     

Spontaneous left main coronary artery dissection

Spontaneous coronary artery dissection (SCAD) is a very rare clinical condition. Physiopathology of SCAD is still mostly unclear. Clinical presentation of SCAD ranges from atypical symptoms to sudden cardiac death. The diagnosis of dissection is generally made by using conventional coronary angiography. Invasive or conservative treatment is reasonable.