急性前壁心肌梗死患者心电图下壁导联ST段改变与其冠状动脉病变的关系

目的　探讨急性前壁心肌梗死患者心电图下壁导联 ST段改变与冠状动脉病变的关系。方法　对 81例冠状动脉左前降支 (L AD)单支病变所致急性前壁心肌梗死患者 ,依其早期心电图下壁导联 ST段改变的形态将患者分为 3组 ,即压低组、抬高组、无改变组 ,并与冠状动脉造影结果进行比较和分析。结果　下壁导联 ST段压低组中73.3%患者为 L AD非优势近端病变 ;抬高组中 6 2 .5 %患者为 L AD优势远端病变 ;无改变组中 L AD优势近端病变与 L AD非优势远端病变所占比例近似。结论　急性前壁心肌梗死患者下壁导联 ST段改变与 L AD形态及病变的部位有关。     

急性前壁心肌梗死时心电图下壁导联ST段改变与左前降支长度和病变部位的关系

目的 探讨急性前壁心肌梗死时下壁ST段改变与左前降支（LAD）长度和病变部位的关系。方法 对75例急性前壁心肌梗死患者的临床资料进行回顾性分析，根据心肌梗死初期是否伴有下壁ST段改变而将患者分成3组，即伴有下壁ST段压低者为I组，伴有下壁ST段抬高者为Ⅱ组，下壁ST段无改变者为Ⅲ组，并与冠状动脉造影结果进行对照。结果 I组中72％患者为LAD非优势近端病变。Ⅱ组中60％患者为LAD优势远端病变；Ⅲ组中LAD优势近端病变与LAD非优势远端病变所占比例相似。结论 急性前壁心肌梗死时下壁ST段改变可能与LAD长度和病变部位有关。     

急性前壁心肌梗死下壁导联ST段变化与前降支形态和梗死部位的关系

目的探讨急性前壁心肌梗死时下壁导联ST段的变化与不同前降支形态和梗死部位关系。方法根据下壁导联心电图ST段改变情况,将67例首发急性前壁心肌梗死病例分为ST段压低组,ST段抬高组和ST段无变化组,与冠状动脉造影结果对照,分析各组心电图变化与前降支形态和梗死部位的关系。结果梗死相关部位在前降支近端者ST段压低组中占81.25%,ST段抬高组占20%,ST段无变化组占46.34%(P<0.01);LAD返折支配1/4以上下壁在ST段压低组中占6.25%,ST段抬高组占70%,ST段无变化组占29.27%(P<0.01)。结论急性前壁心肌梗死时下壁导联ST;段变化与前降支梗死部位和形态有关。下壁导联ST段压低提示前降支近端梗死,ST段抬高提示前降支远端梗死且存在前降支返折。     

急性前壁心肌梗死时下壁导联ST段压低的临床意义

目的 :探讨急性前壁心肌梗死合并下壁导联 ST段压低的临床意义。方法 :回顾性分析2 2例首发急性前壁心肌梗死患者的心电图、冠状动脉及左室造影资料。结果 :急性前壁心肌梗死时下壁导联 ( 、 、a VF) ST段下移≥ 0 .0 5 m V组与 <0 .0 5 m V组的 、a VL导联 ST80 值有显著性差异 ( P <0 .0 5 ) ;两组的左前降支 6段 ( LAD6 )或 LAD始部病变的发生率也有显著性差异 ( P <0 .0 5 ) ;下壁导联 ST段压低≥ 0 .0 5 m V对 L AD6 或 LAD始部病变预测价值的敏感性及特异性分别是 : 导联 5 9%、5 0 % ; 导联 83%、70 % ;a VF导联 83%、70 %。结论 :急性前壁心肌梗死时下壁导联ST段压低预示 LAD6 或 L AD始部病变是高前侧壁发生透壁性心肌缺血的“镜像”反应 ,表现为 、a VL导联 ST段抬高 ;它与右冠状动脉、左旋支、多支病变以及胸前导联 ST段抬高程度无关     

下壁ST段压低与急性前壁心肌梗死的相关性

目的　探讨心电图下壁导联ST段压低与急性前壁心肌梗死 (AMI)的相关性。方法　连续评价 6 3例前壁AMI病人 ,选择病人就诊初始 4h心电图测量其ST水平。住院 1～ 2周行冠状动脉造影 (CAG)同位素心肌灌注显像检查结果对照分析 ;结果　①选择性冠状动脉造影显示冠状动脉病变支数无显著差异 ,左心室造影下壁运动无明显减弱 ;②同位素心肌灌注显示下壁ST段压低组 86 2 1%无下壁心肌缺血表现 ;③下壁导联ST压低组V1 3 导联ST抬高的平均值明显高于不伴下壁导联ST压低组 ,ECG下壁ST段压低明显与V1 3 导联抬高有相关性 ,(r =- 0 5 2 ,P <0 0 5 )。结论　下壁导联ST段压低可能是前壁AMI时V1 3 导联ST抬高的镜影反映而不是下壁心肌缺血表现。     

肢体导联ST段改变对急性前壁心肌梗死患者冠脉闭塞部位的预测价值

目的：结合冠状动脉造影结果分析肢体导联ST段改变对判断急性前壁心肌梗死患者冠脉闭塞部位的预测价值。方法入选84例因急性前壁梗死行冠状动脉造影检查的患者,对其发病后心电图肢体导联ST段改变的情况进行分析。结果冠状动脉造影发现,前降支近端病变（伴或不伴远端病变）,肢体导联Ⅱ、Ⅲ、aVF多表现为ST段压低≥0．1 mV;前降支远端病变（不伴近端病变）,肢体导联Ⅱ、Ⅲ、aVF的ST段多表现为抬高或无明显压低。结论对于急性前壁心肌梗死患者,心电图肢体导联ST段改变可以预测冠状动脉闭塞部位,对早期诊断和治疗方案选择有一定的指导意义。     

急性下壁心肌梗死患者心电图胸前导联ST段改变的临床意义

目的探讨急性下壁心肌梗死患者心电图胸前导联ST段改变与冠状动脉造影(CAG)所见冠状动脉病变部位的关系及其临床意义。方法 187例急性下壁心肌梗死患者,按入院时18导心电图胸前导联ST段改变分为3组,ST段无变化组(47例),ST段抬高组(16例),ST段压低组(124例);所有患者均行CAG。结果急性下壁心肌梗死伴胸前导联ST段抬高时多为右冠状动脉(RCA)近段闭塞(14例,82.3%),尤其是伴圆锥支动脉闭塞,与RCA中远端闭塞(2例,5.9%)比较差异有统计学意义(P0.01),且14例(73.7%)伴有右心功能不全和血流动力学障碍。下壁心肌梗死胸前导联ST段压低者可见于RCA、回旋支(LCX)闭塞及RCA、LCX闭塞与前降支(LAD)、对角支(D)病变的不同组合,其中LCX闭塞伴RCA病变者多表现为朐前ST V_4～V_6的压低,RCA闭塞伴LAD近端病变多有胸前ST V_1～V_6的压低,RCA伴D病变胸前ST V_1～V_3压低,与对照组比较差异有统计学意义(P0.05)。结论急性下壁心肌梗死合并胸前导联ST段抬高表明为RCA近段或丌口闭塞且多伴右心室心肌梗死和心功能不全;下壁心肌梗死伴胸前导联ST段压低提示为多支病变,ST V_1～V_3压低多伴有对角支严重狭窄,STV_1～V_6压低多伴有前降支的严重狭窄。     

前壁急性心肌梗死时下壁ST段压低的意义

目的 :前瞻性研究前壁急性心肌梗死 ( AMI)病人下壁 ST段压低的意义。方法 :连续评价前壁 AMI病人 ,选择病人就诊头 3h心电图 ( ECG)测量其 ST段水平 ,并于住院第 10～ 2 1天行冠状动脉造影 ( CAG) ,评估左冠前降支 ( L AD)梗塞相关病变与第一对角支 ( D1)开口的位置关系。结果 :入选 85例中 2例 CAG阴性。余 83例分两组 ,A组为 LAD病变在 D1开口前或 D1开口后但合并 D1病变 ( 63例 ) ,B组为 D1开口后但不合并 D1病变 ( 2 0例 )。83例中 、 、a VF导联 ST段压低≥ 1mm者分别为 2 7、38、38例。以 、a VF导联 ST段压低≥ 1mm预测 A组病变的阳性预测值分别为92 .1%和 89.5 % ( P <0 .0 5 )。结论 :前壁 AMI时下壁 ST段压低提示 LAD近端病变或 LAD远端病变合并 D1病变。     

急性下壁心肌梗死心电图胸前导联V1-3 ST段抬高的临床意义

目的 探讨急性下壁心肌梗死患者心电图胸前导联ST段抬高与冠状动脉造影所示冠状动脉病变的关系及其临床意义.方法 187例急性下壁心肌梗死患者,按入院时18导心电图胸前导联ST段改变分为2组,ST段抬高组（16例）和非ST段压低组（171例）.所有患者均行冠状动脉造影术,病变适合行经皮腔冠状动脉成型术并检测B型钠尿肽（BNP）.结果 急性下壁心肌梗死伴胸前导联ST段抬高时多为右冠状动脉近段闭塞,尤其是圆锥支闭塞（P＜0.01）,且伴有右心功能不全和血流动力学障碍,与下壁右室心梗相比BNP差异有统计学意义（P＜0.01）.结论 急性下壁心肌梗死合并胸前导联ST抬高表明为右冠状动脉近段或开口闭塞且多伴右室心肌梗死和心功能不全.     

急性下壁心肌梗死ST段改变与相关冠状动脉阻塞的关系

目的探讨急性下壁心肌梗死时心电图ST段改变与相关冠状动脉阻塞的关系。方法对30例急性下壁心肌梗死ST段改变与冠状动脉造影结果对比分析。结果急性心肌梗死部位下壁12例、下壁+正后壁5例、下壁+右心室8例、下壁+前壁5例。其中单支病变10例,双支病变12例,三支病变8例。右冠状动脉狭窄87.7%,左回旋支狭窄12.2%。ST段抬高Ⅲ>Ⅱ,压低aVL>Ⅰ,诊断右冠状动脉阻塞,敏感性、特异性分别为95.0%、93.4%。V4导联ST段压低与Ⅲ导联ST段抬高比值>0.5,可诊断左回旋支阻塞,敏感性、特异性分别为84.9%和79.4%,ST段抬高Ⅰ>aVL、压低Ⅱ>Ⅲ,提示左回旋支阻塞,敏感性、特异性分别为52.1%和78%。结论急性下壁心肌梗死心电图ST段抬高Ⅲ>Ⅱ、ST段压低aVL>Ⅰ,提示右冠状动脉阻塞,V4导联ST段压低与Ⅲ导联ST段抬高比值>0.5,ST段抬高Ⅰ>aVL、ST段压低Ⅱ>Ⅲ,提示左回旋支阻塞。     

Relation of ST-segment changes in inferior leads during anterior wall acute myocardial infarction to length and occlusion site of the left anterior descending coronary artery

We investigated the relation between left anterior descending (LAD) coronary artery morphology and inferior lead ST-segment changes to elucidate the clinical significance of such changes in 159 patients with anterior wall acute myocardial infarction (AMI). Patients with 1-vessel LAD artery lesions were divided into an ST depression group (n = 40), an ST elevation group (n = 25), and a no-ST-change group (n = 94) based on ST-segment changes in the inferior leads. The relation between each group and the infarct-related lesion and the presence of a wrapped LAD artery was then investigated. The percentage of patients with the infarct-related lesion in the proximal LAD artery was significantly higher in the ST depression group and significantly lower in the ST elevation group. The percentage of patients with a wrapped LAD artery was significantly higher in the ST elevation group and significantly lower in the ST depression group. The wall motion index determined echocardiographically was significantly higher in the ST depression group and the no-ST-change group than in the ST elevation group. Our findings suggest that inferior lead ST-segment changes during anterior wall AMI arise as a result of competition between reciprocal changes caused by high lateral wall AMI due to lesions of the proximal LAD artery, which depress the ST segment, and inferoapical wall AMI due to a wrapped LAD artery, which elevates the ST segment. In patients with no ST-segment changes, echocardiography was useful for distinguishing the amount of affected LAD artery territory.     

急性前壁心肌梗死伴不同下壁导联ST段改变的临床特点

目的探讨ST段抬高急性前壁心肌梗死(简称心梗)伴不同下壁导联ST段改变患者的梗死相关血管以及梗死面积及心功能情况。方法73例急性前壁心梗患者,根据入院时心电图下壁导联ST段改变情况将患者分为3组:A组为Ⅱ、Ⅲ、aVF中至少两个导联ST段抬高;B组为Ⅱ、Ⅲ、aVF中至少两个导联ST段压低,C组为Ⅱ、Ⅲ、aVF中少于两个导联ST段有改变。比较三组CK最大值,左室射血分数以及梗死相关血管(IRCA)。结果CK最大值3组比较A组最低(1280±531IU/Lvs2034±911,1677±630IU/L,P<0.01);左室射血分数A组最高(0.54±0.09vs0.48±0.07,0.47±0.08,P<0.01);三组IRCAA组中85.7%的患者位于“绕过心尖的左前降支(LAD)”的中远段,有14.3%的患者位于右冠状动脉(RCA)的近段;B组的患者中全部为非“绕过心尖的LAD”,其中有70.4%的患者位于非“绕过心尖的LAD”的近段;C组中有96.7%的患者为非“绕过心尖的LAD”,其中有73.3%的患者位于非“绕过心尖的LAD”的近中段,三组比较差异有显著性(P<0.01)。结论IRCA为LAD的急性前壁心梗时下壁ST段改变可能与LAD长度和病变部位有关;前壁合并下壁ST段同时抬高的患者若IRCA为“绕过心尖的LAD”,其梗死面积较小,心功能较好。     

急性前壁心肌梗死并下壁导联ST段压低与冠状动脉病变的关系

目的：观察急性前壁心肌梗死下壁导联ＳＴ段压低与冠状动脉病变的关系。方法：对６６例急性前壁心肌梗死患者均常规行冠状动脉造影术,根据常规心电图下壁导联ＳＴ段压低＞１ｍｍ分为ＳＴ段压低组（４８例）与ＳＴ段正常组（１８例）,比较分析心电图与冠状动脉造影之间的关系。结果：急性前壁心肌梗死患者２７．３％有下壁导联ＳＴ段压低,ＳＴ段压低组中冠状动脉病变支数与正常组无显著性差异（Ｐ＞０．０５）,７３．２％为左前降支（ＬＡＤ）近端病变,显著高于ＳＴ段正常组（４５．８％）。ＳＴ段压低组５５．６％伴有心电图ＳＴＩ,ａＶＬ抬高,显著高于ＳＴ段正常组（４．２％）（Ｐ＜０．０１）。结论：急性前壁心肌梗死并下壁导联ＳＴ段压低与冠状动脉病变支数无关,而与ＬＡＤ近端病变有关,可能反映高侧壁心肌缺血时的心电图对应性改变。     

体表心电图对老年急性前壁心肌梗死左前降支闭塞部位的预测价值

目的探讨体表心电图对老年急性前壁心肌梗死左前降支（LAD）闭塞部位的预测价值。方法对62例老年急性前壁心肌梗死患者的入院心电图和冠状动脉造影资料进行回顾性分析,寻找可以预测LAD闭塞部位的心电图改变。结果62例老年急性前壁心肌梗死患者均为LAD闭塞,其中近段闭塞者45例（72.6%）,远段闭塞者17例（27.4%）。经χ2检验,STⅠ抬高、STaVL抬高、STaVF压低或至少2个下壁导联ST段压低等指标提示LAD近段闭塞（P均〈0.05）。其中,STaVF压低或至少2个下壁导联ST段压低的特异度和阳性预测值最高,为94%左右,灵敏度以STaVL抬高最高,为56%;反之,STaVL压低和STⅢ抬高则在预测LAD远段闭塞上有显著意义（P均〈0.05）,特异度和阳性预测值以STaVL压低为最高,均为100%。结论急性前壁心肌梗死时,体表心电图对预测LAD闭塞部位有重要价值。     

Clinical significance of precordial ST segment depression during acute inferior myocardial infarction

To investigate the mechanisms and clinical significance of precordial (V1-V4) ST segment depression during acute inferior myocardial infarction, stress thallium-201 scintigrams and coronary angiograms were obtained within four to eight weeks after the onset of myocardial infarction in 37 patients experiencing their first acute inferior myocardial infarction. Among 18 patients with precordial ST depression (group 1), 11 with concomitant disease of the left anterior descending artery (LAD) had positive results on exercise test, whereas in seven patients without LAD lesion, only two had positive exercise test (p less than 0.01). In 19 patients without precordial ST depression (group 2), 11 had severe stenosis in the LAD. However, among these 11 patients, only two had positive exercise tests. Patients with precordial ST depression demonstrated a higher frequency of positive exercise tests than those without it (p less than 0.01). On stress thallium-201 scintigraphy, a perfusion defect involving the inferior wall was present in all patients, but additional anterior wall ischemia was present in only five of the 18 patients in group 1. These five patients had chest pain on exercise tests and a severe stenosis greater than 90% in the LAD. There was no significant difference in the frequency of additional posterolateral wall infarction between groups 1 and 2. In 18 patients in group 1, sigma ST (total degrees of ST segment depression in leads V1, V2, V3, and V4 in the acute stage) was significantly greater in 11 patients with LAD lesion than in seven without (p less than 0.05), and sigma ST greater than five mm was observed in 12 of 13 patients who had additional anterior wall ischemia and posterolateral wall infarction on stress thallium-201 scintigraphy (p less than 0.05). Myocardial revascularization, such as aortocoronary bypass surgery or percutaneous transluminal coronary angioplasty (PTCA), was performed in six of the 18 patients in group 1 in the chronic stage, but in only one of the 19 patients in group 2. Thus, in patients with initial acute inferior myocardial infarction, those with precordial ST depression seemed to be a high-risk group. It was suggested that, during the early stage of myocardial infarction, this abnormality on electrocardiograms is related to the summation of effects of anterior wall ischemia and posterolateral wall infarction. Furthermore, the sigma ST evaluation is useful in differentiating a mirror image of inferior wall infarction from anterior wall ischemia and posterolateral wall infarction as the mechanism of precordial ST depression.     

急性前壁心肌梗死伴下壁导联ST段下移的临床意义

目的　探讨急性前壁心肌梗死患者入院时心电图下壁导联 ST段下移与临床预后及左冠状动脉前降支“罪犯”血管病变部位之间的关系。方法　选择 1998年 1月～ 2 0 0 2年 10月住院诊治并行冠状动脉造影的急性前壁心肌梗死患者 5 9例 ,依据冠状动脉造影所示左前降支“罪犯”血管病变部位与第一对角支起始部的关系分成两组 , 组 36例病变部位位于第一对角支发出前 , 组 2 3例病变位于第一对角支发出后。结果　 组 36例占 6 1.0 1% , 组 2 3例占 38.98%。 组病人多数合并下壁导联 ST段下移≥ 1mm ,在 、 、a VF导联分别为 81% ,92 % ,79%。 组多数 ST段位于等电位线或 ST段下移 <1m m,在 、 、a VF导联分别为 6 0 % ,6 1% ,5 3%。结论　急性前壁心肌梗死患者入院时心电图下壁导联 ST段下移可以预测“罪犯”血管病变部位位于第一对角支起始部近端 ,而 ST段位于等电位线或 ST段下移 <1mm预示病变部位位于前降支远端     

Implications of inferior ST-segment elevation accompanying anterior wall acute myocardial infarction for the angiographic morphology of the left anterior descending coronary artery morphology and site of occlusion.

Inferior ST-segment elevation during anterior wall acute myocardial infarction (AMI) due to left anterior descending (LAD) coronary artery occlusion is unusual and was not previously investigated. This study tested the hypothesis that inferior ST-segment elevation during anterior AMI predicts a specific angiographic morphology that satisfies 2 necessary conditions: (1) mass of ischemic anterior wall myocardium is relatively small, resulting in a weaker anterior injury current and less reciprocal inferior ST-segment depression; and (2) there is concomitant inferior wall transmural ischemia that further shifts the inferior ST segments upward. The study group consisted of 42 consecutive patients with anterior AMI undergoing angiography at 4.1 days (range 0 to 14). Coronary angiograms were examined for 3 features: (1) site of LAD artery occlusion (a distal obstruction implying a smaller mass of ischemic anterior wall myocardium), (2) LAD artery extension onto inferior wall of left ventricle (termed a "wrap around" vessel), and (3) collateral flow from LAD artery to inferior wall. The latter 2 features would be expected to contribute to inferior wall transmural ischemia. Acute inferior ST-segment elevation (sum of ST-segment deviation in leads II, III and aVF greater than or equal to 3.0 mm) was seen in 7 patients (16%). A greater number of LAD artery branches proximal to the site of occlusion was significantly correlated with less inferior ST-segment depression (r = 0.59, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)