aVR导联ST段抬高对非ST段抬高型急性心肌梗死的意义

目的：探讨aVR导联ST段抬高（ ST segment elevation ,STSE）对于非STSE型急性心肌梗死（ acute myocardial infarction , AMI ）的预测价值。方法回顾性分析425例非STSE 型AMI患者的心电图资料,并观察各导联ST段压低情况及是否存在T波倒置。对所测定数据进行整理和统计学处理。结果 aVR导联STSE多见于完全性右束支阻滞、左心室肥厚以及V1导联STSE的患者,在其他导联广泛ST段压低的患者中也较为多见;此类情况在T波倒置患者中较少见。本研究中,22例在住院时死亡,其中5例死于心源性休克。患者住院死亡率的不断升高和aVR导联STSE的等级不断上升相关。多重变量分析表明,aVR导联STSE已经成为预测住院死亡的独立重要变量。 aVR导联STSE大都与住院患者的心肌缺血时间以及发生心力衰竭相关,但是与血清肌酸激酶或肌酸激酶同工酶 MB 的水平高低没有相关性。结论如果aVR导联STSE和严重冠状动脉病变之间的联系,能够在大样本非STSE型AMI患者群体中得到进一步验证,那么aVR导联STSE就可以成为选择早期介入治疗患者的一个较为有用的指标。     

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。     

aVR导联ST段抬高对急性前壁心肌梗死的预后价值研究

目的探讨aVR导联ST段抬高对急性前壁心肌梗死患者的预后价值。方法根据心电图aVR导联ST段变化将84例急性前壁心肌梗死患者分为ST段抬高组（A组,44例）及ST段无抬高组（B组,40例）,对比分析两组患者的心电图和冠状动脉造影（CAG）及心血管事件发生率。结果 （1）梗死相关血管为左主干病变的A组9例（20.45%）与B组1例（2.50%）,两组统计有显著性差异（P〈0.05）;（2）梗死相关血管为三支病变的A组27例（61.36%）与B组10例（25.00%）,两组统计有显著性差异（P〈0.05）;（3）发生心血管事件的A组10例（22.73%）与B组3例（7.50%）,两组统计有显著性差异（P〈0.05）。结论 aVR导联ST段抬高对急性前壁心肌梗死患者预后有重要预测价值,应高度重视。     

aVR导联ST段抬高预测心肌梗死患者的预后

非ST段抬高型急性心肌梗死（AMI）的病生理机制、梗死范围和受累心肌数量均可能存在差异，早期的危险分层对指导选择适当的治疗方案很有帮助。体表ECG已被广泛用于危险分层，非ST段抬高型AMI病人入院ECG时ST段压低已被认为是住院不良心脏事件最强的预测因子之一。以往研究表明在不稳定性心绞痛或ST段抬高型AMI病人，aVR导联ST段抬高合并复极异常提示严重冠状动脉（冠脉）病变的存在。本研究目的是探讨aVR导联ST段抬高在预测首次非ST段抬高型AMI病人中短期预后的价值。     

急性心肌梗死aVR导联ST段抬高的临床意义

目的 探讨体表心电图aVR导联ST段抬高对急性心肌梗死患者梗死相关血管(IRA)诊断及临床预后的意义.方法 收集2010年10月至2012年12月因急性心肌梗死入住我院的患者共240例,根据患者入院时心电图aVR导联ST段有无抬高,分为A组(AVR导联ST段抬高)80例和B组(aVR导联ST段无抬高)160例,对两组患者临床资料、冠状动脉造影结果及主要不良心血管事件进行对比.结果 ①两组患者性别、糖尿病病史、PCI病史等一般临床资料对比差异无统计学意义(P＞0.05).②两组冠状动脉造影结果比较:IRA为左主干(LM),A组9例,B组3例,两组比较差异有统计学意义(P＜0.01);IRA左主干和(或)三支血管(LM/3VD),A组46例,B组15例,两组比较差异有统计学意义(P＜0.01).③aVR导联ST抬高对IRA为左主干的敏感性及特异性分别为75％和69％,对IRA为左主干和(或)三支病变的敏感度及特异度分别为73％和81％.④住院期间主要不良心血管事件(MACE),A组36例,B组25例,两组比较差异有统计学意义(P＜0.01).⑤在住院期间,aVR导联ST段抬高(OR=10.03,95％CI=5.36～18.77,P＜0.01)是急性心肌梗死患者发生不良心血管事件的独立危险因素.结论 aVR导联ST段抬高提示急性心肌梗死患者梗死相关血管为左主干和(或)三支血管病变及住院期间不良心血管事件发生率增高.aVR导联ST段抬高对急性心肌梗死患者梗死相关血管判断及临床预后具有一定的临床指导意义.     

aVR导联的直立T波对非ST段抬高型心肌梗死患者的预后评估价值

目的探讨a VR导联中的直立T波在预测非ST段抬高型心肌梗死(NSTEMI)患者预后的临床价值。方法回顾性纳入2011年1月至2016年12月期间收治的400例NSTEMI患者,根据心电图a VR导联中的T波>0 m V将患者分为直立T波组(124例)和非直立T波组(276例),随访12个月记录主要不良心脑血管事件(MACCE)。单因素及多因素logistic回归分析影响MACCE发生的独立危险因素。结果直立T波组的左室射血分数低于非直立T波组(P<0. 05),而年龄、心率、高血压、糖尿病、心力衰竭(Killip 3～4级)、左心室肥大和a VR导联ST段抬高比例均显著高于非直立T波组(均为P<0. 05)。中位随访14. 5(12～27)个月后,直立T波组中的院内死亡、心力衰竭、心原性休克、再发心肌梗死等均明显高于非直立T波组(均为P<0. 05)。多因素logistic回归发现,左室射血分数<40%[比值比(OR)=1. 432,95%CI:1. 204～2. 411,P=0. 043]、a VR导联直立T波(OR=3. 748,95%CI:2. 855～5. 392,P<0. 001)和a VR导联ST段抬高(OR=2. 439,95%CI:2. 208～3. 956,P<0. 001)是发生MACCE的独立危险因素。结论 a VR导联的直立T波能够有效预测NSTEMI患者冠状动脉介入术后12个月内MACCE发生风险增加。     

急性右心室梗死表现aVR导联ST段明显抬高

患者男,81岁。因气急胸闷加重1h于1987年12月9日入院,于1987年12月20日出现活动后胸闷、气急、伴随冷汗、恶心、呕吐,反复加重。既往有高血压病史多年,查体163/83mmHg,脉搏90次/min,不能平卧,颈静脉怒张,胸廓正常,右下肺可闻及哮鸣音和少许干湿罗音,伴双下肢浮肿。心电图示:窦性心律,右胸导联V_3R～V_5R呈Qr型,ST     

aVR导联ST抬高对急性非ST段抬高型心肌梗死者左主干或三支血管病变的预测

目的研究急性非ST段抬高型心肌梗死(NSTE-AMI)者aVR导联抬高幅度,与冠状动脉造影(CAG)对比,判断其对左主干/三支病变(LM/3VD)诊断的指导作用。方法对比106例aVR导联ST段抬高程度,结合CAG结果,研讨诊断LM/3VD的敏感性、特异性及相关性。结果 aVR导联ST段抬高是LM/3VD的独立预测因子(P<0.01),aVR导联ST段抬高≥0.5mm预测LM/3VD的敏感性及特异性分别为76%、86%。ST段抬高≥1.0mm预测LM/3VD的敏感性及特异性分别为43%、96%,ST段抬高≥1.5mm预测LM/3VD的敏感性及特异性分别为18%、99%。结论 aVR导联ST段抬高是NSTE-AMI者LM/3VD非常有用的预测因子,特异性好。     

肌钙蛋白Ⅰ结合心电图aVR导联ST段变化对非ST段抬高型急性冠状动脉综合征临床预后的评估

目的结合实验室检测肌钙蛋白Ⅰ与心电图aVR导联ST段抬高情况,探讨二者在非ST段抬高型急性冠状动脉综合征患者的预后评估中的价值。方法入选非ST段抬高型急性冠状动脉综合征患者255例,采血检验肌钙蛋白Ⅰ,并详细测量心电图AVR导联ST段抬高情况,均行冠脉造影,根据具体情况分别行冠脉介入治疗、冠脉搭桥手术及药物保守治疗,随访6个月,观察终点为不良心血管事件,包括心肌梗死(包括再梗)、心血管死亡和血运重建。结果在随访的6个月内,肌钙蛋白Ⅰ值(OR=7.01,95%CI=1.22～12.63,P=0.02)和aVR导联ST段抬高值(OR=1.38,95%CI=1.084～1.751,P=0.009)是患者发生死亡和心肌梗死(包括再梗)的独立危险因素;同时,肌钙蛋白Ⅰ值(OR=1.249,95%CI=1.114～1.501,P0.01)和aVR导联ST段抬高值(OR=2.03,95%CI=1.20～4.29,P=0.04)亦是患者不良心血管事件(包括死亡、心肌梗死及血运重建术)发生的独立危险因素。在NSTE-ACS患者中,肌钙蛋白Ⅰ的升高的同时aVR导联ST段抬高者,其左主干病变或三支冠状动脉血管病变发生,以及不良心血管事件(包括死亡、心肌梗死、再梗、血运重建)的发生均是最高的。结论在临床中结合肌钙蛋白Ⅰ和心电图aVR导联ST段变化,可以早期应用于非ST段抬高型急性冠状动脉综合征患者预后的判断。     

急性右室梗死致aVR导联ST段弓背型抬高心电图分析

本文对 2 0 0 1年 3月～ 2 0 0 2年 6月我院收治的 3 6例右室梗死 (ＡＲＭＩ)作回顾分析。发现 5例ＡＲＭＩ时ａＶＲ导联ＳＴ段呈弓背型抬高。对此分析有助于进一步探讨和提高对ＡＲＭＩ的诊治水平。病例均根据 1979年ＷＨＯ诊断标准 ,心电图以Ｖ4Ｒ 导联ＳＴ抬高≥ 0 .1ｍＶ ;Ｖ1 、Ｖ3Ｒ、Ｖ4Ｒ导联均呈ＱＳ型 ;Ⅲ导联出现异常Ｑ波及ＳＴ段抬高 ,Ｖ1 ～Ｖ3导联ＳＴ段抬高逐渐减轻[1 ] 作为急性ＡＲＭＩ的诊断标准。1　资料与方法例 1　男 ,68岁。因心悸、胸闷伴头昏 3ｄ ,气喘加重 8ｈ入院 ,心肌酶谱 :ＡＳＴ 15 0ｕ Ｌ ,ＬＤＨ 64 0ｕ Ｌ…     

Determinants of ST-segment level in lead aVR in anterior wall acute myocardial infarction with ST-segment elevation

Background

This study aimed to clarify the determinants of ST-segment level in lead aVR in anterior wall acute myocardial infarction (AAMI).

Methods

We analyzed ST-segment levels in all 12 leads on admission and emergency coronary angiographic findings in 261 patients with a first AAMI with ST-segment elevation. The length of the left anterior descending coronary artery (LAD) was classified as follows: short = not reaching the apex; medium = perfusing less than 25% of the inferior wall; long = perfusing 25% or more of the inferior wall.

Results

The ST-segment level in lead aVR correlated significantly with the ST-segment levels in leads I, II, III, aVF, V₁, and V_3-6, especially with those in leads II and V₆ (r = −0.63, P < .001; r = −0.61, P < .001; respectively). Patients with a proximal LAD occlusion had a greater ST-segment level in lead aVR than those with a distal LAD occlusion (P < .001). Patients with a long LAD had a lower ST-segment level than those with a short or medium LAD (P < .05).

Conclusions

The ST-segment levels, especially in leads II and V₆, the site of the LAD occlusion, and the length of the LAD affect the ST-segment level in lead aVR in ST-segment elevation AAMI.     

Prognostic value of combination of ST-segment elevation in lead aVR and positive cTnI in patients with non-ST-segment elevation acute coronary syndrome

Background Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is an acute heart disease caused by incomplete occlusion of related coronary arteries with unstable atherosclerotic plaques. Lead a VR STsegment elevation and c Tn I positive are closely correlated to the prognosis of NSTE-ACS patients. However,there are few studies applying the two predictors to early risk stratification in NSTE-ACS patients. Method Two hundred and five cases of NSTE-ACS patients followed up for 6 months after discharge were reviewed. All patients were divided into four groups:Group A-c Tn I negative combined with a VR-non-ST-segment elevation group (100 cases) ;Group B-c Tn I negative combined with a VR-ST-segment elevation group (31 cases) ;Group C-c Tn I positive combined with a VR-non-ST-segment elevation group (43 cases) ;Group D-c Tn I positive combined with a VR-ST-segment elevation group (31 cases) . There was no significant difference in gender,age,old myocardial infarction,previous PCI history,hypertension,and diabetes between a VR-ST elevation group and no a VR-ST elevation group. The morbidity of left main or three-vessel coronary artery disease as well as adverse cardiovascular events in the four groups were observed and analyzed. Results (i) The morbidity of left main or three-vessel coronary artery disease was highest in Group D (87.1%),and was markedly higher in Group B (41.9%) than that in Group A (7%) or Group C (9.3%) ; (ii) The incidence of adverse cardiovascular events was highest in Group D (77.4%),and was much higher in B (35.5%) as compared with that tin Group A (1%) or group C (7%) . Conclusion Electrocardiographic lead a VR ST-segment elevation combined with c Tn I positive has an important clinical value in predicting the prognosis of the patients with NSTE-ACS.     

Short- and long-term prognostic significance of ST-segment elevation in lead aVR in patients with non-ST-segment elevation acute coronary syndrome

We sought to evaluate the prognostic significance of ST-segment elevation (STE) in lead aVR in unselected patients with non-STE acute coronary syndrome (NSTE-ACS). We enrolled 1,042 consecutive patients with NSTE-ACS. Patients were divided into 5 groups according to the following electrocardiographic (ECG) patterns on admission: (1) normal electrocardiogram or no significant ST-T changes, (2) inverted T waves, (3) isolated ST deviation (ST depression [STD] without STE in lead aVR or transient STE), (4) STD plus STE in lead aVR, and (5) ECG confounders (pacing, right or left bundle branch block). The main angiographic end point was left main coronary artery (LM) disease as the culprit artery. Clinical end points were in-hospital and 1-year cardiovascular death defined as the composite of cardiac death, fatal stroke, and fatal bleeding. Prevalence of STD plus STE in lead aVR was 13.4%. Rates of culprit LM disease and in-hospital cardiovascular death were 8.1% and 3.8%, respectively. On multivariable analysis, patients with STD plus STE in lead aVR (group 4) showed an increased risk of culprit LM disease (odds ratio 4.72, 95% confidence interval [CI] 2.31 to 9.64, p <0.001) and in-hospital cardiovascular mortality (odds ratio 5.58, 95% CI 2.35 to 13.24, p <0.001) compared to patients without any ST deviation (pooled groups 1, 2, and 5), whereas patients with isolated ST deviation (group 3) did not. At 1-year follow-up 127 patients (12.2%) died from cardiovascular causes. On multivariable analysis, STD plus STE in lead aVR was a stronger independent predictor of cardiovascular death (hazard ratio 2.29, 95% CI 1.44 to 3.64, p <0.001) than isolated ST deviation (hazard ratio 1.52, 95% CI 0.98 to 2.36, p = 0.06). In conclusion, STD plus STE in lead aVR is associated with high-risk coronary lesions and predicts in-hospital and 1-year cardiovascular deaths in patients with NSTE-ACS. Therefore, this promptly available ECG pattern could be useful to improve risk stratification and management of patients with NSTE-ACS.     

非ST段抬高与ST段抬高型急性心肌梗死冠状动脉病变特征比较

目的比较非ST段抬高型急性心肌梗死(NSTEAMI)与ST段抬高型急性心肌梗死(STEAMI)冠状动脉病变的特点。方法回顾NSTEAMI与STEAMI患者的临床及冠状动脉造影资料,分析二者的临床特点及冠状动脉病变血管的支数、狭窄程度及侧支循环情况。结果NSTEAMI组的多支病变率为76.00%、≥75%的严重狭窄率为53.00%,侧支循环率为36.00%,三者均高于STEAMI组,而完全闭塞率为10.00%,低于STEAMI组。两组间高血压、糖尿病患病率差异无统计学意义。在病变血管的构成上组间无差异。结论NSTEAMI的冠状动脉病变程度高于STEAMI,完全闭塞率低于后者,二者具有不同的冠状动脉病变特点。     

缺血分级在急性ST段抬高型心肌梗死的临床价值

目的探讨缺血分级对接受急诊经皮冠状动脉介入(primary percutaneous coronary intervenfion,PPCI)治疗的急性ST段抬高型心肌梗死(ST-segment elevation acute myocardial infarction,STEMI)患者的临床价值。方法对接受PPCI治疗的STEMI患者181例,按心电图表现分为Ⅱ级缺血组和Ⅲ级缺血组,观察两组院内心血管事件的发生率,分析患者术后心电图ST段回落与心电图缺血分级的关系。结果Ⅲ级缺血组血清肌酸激酶同工酶(CK-MB)浓度明显高于Ⅱ级缺血组,差异有统计学意义[(370±115)U/I vs.(211±91)U/I,P0.01];左心室射血分数明显低于Ⅱ级缺血组,差异有统计学意义(38%±12%vs.53%±11%,P0.05)。Ⅲ级缺血组恶性室性心律失常,心源性猝死,心力衰竭,严重房室传导阻滞等心血管事件发生率(34.0%,12.6%,42.7%,35.0%)明显高于Ⅱ级缺血组(14.1%,3.8%,17.9%,15.4%),差异有统计学意义(P0.01)。PPCI治疗后2 hⅢ级缺血组ST段回落一半及以上和ST段完全回落发生率(32.0%,22.3%)明显低于Ⅱ级缺血组(44.9%,38.5%),差异有统计学意义(P0.05;P0.01);PPCI治疗后24 hⅢ级缺血组ST段完全回落的发生率也明显低于Ⅱ级缺血组,差异有统计学意义(54.4%vs.84.6%,P0.001)。COX风险比例模型单因素分析结果显示,Ⅲ级缺血是心肌梗死患者心源性猝死和心血管事件的独立预警指标(P0.01)。结论Ⅲ级缺血是STEMI患者住院期间心血管事件和ST段回落不良的独立预测因子。     

ST-segment depression in lead aVR predicts predischarge left ventricular dysfunction in patients with reperfused anterior acute myocardial infarction with anterolateral ST-segment elevation.

BACKGROUND: Patients with an anterolateral acute myocardial infarction (AMI) have a worse prognosis, and those with additional inferolateral wall involvement might be higher risk because of more extensive area at risk. Lead -aVR obtained by inversion of images in lead aVR has been reported to provide useful information for inferolateral lesion. METHODS: We examined the relation between ST-segment deviation in lead aVR on admission electrocardiogram (ECG) and left ventricular function in 105 patients with an anterolateral AMI undergoing successful reperfusion < or = 6 hours after onset. Patients were classified according to ST-segment deviation in lead aVR on admission ECG: group A, 23 patients with ST elevation of > or = 0.5 mm; group B, 47 patients without ST deviation; and group C, 35 patients with ST depression of > or = 0.5 mm. RESULTS: There were no differences among the 3 groups in age, sex, or site of the culprit lesion. In groups A, B, and C, the peak creatine kinase level was 3661 +/- 1428, 4440 +/- 1889, and 6959 +/- 2712 mU/mL, and the left ventricular ejection fraction (LVEF) measured by predischarge left ventriculography was 54% +/- 9%, 48% +/- 7%, and 37% +/- 9%, respectively(P < .01). During hospitalization, congestive heart failure occurred more frequently in group C than in groups A or B (P < .05). ST-segment depression in lead aVR had a higher predictive accuracy than other ECG findings in identifying patients with predischarge LVEF < or = 35%. CONCLUSIONS: We conclude that in patients with an anterolateral AMI, ST-segment depression in lead aVR on admission ECG is useful for predicting larger infarct and left ventricular dysfunction despite successful reperfusion.