急性前壁心肌梗死病人aVR导联ST段变化的临床意义

目的 探讨急性前壁心肌梗死病人aVR导联ST段变化的临床意义.方法 首次急性前壁心肌梗死病人66例,均行冠状动脉造影,依据心电图aVR导联ST段变化将病例分为无偏移组、抬高组和下移组.结果 梗死相关血管为左主干病变的无偏移组、抬高组、下移组分别为0例、4例、1例,ST段抬高组与无偏移组有统计学意义(P<0.05);病变范围为多支病变无偏移组、抬高组、下移组分别为3例、18例、5例,ST段抬高组与无偏移组、下移组与无偏移组均有统计学意义(P<0.05);发生心脏事件无偏移组、抬高组、下移组分别为1例、9例、2例,ST段抬高组与无偏移组有统计学意义(P<0.05).结论 急性前壁心肌梗死病人如果aVR导联ST段抬高或下移可能提示有严重的左主干病变或严重的多支病变,且有大面积的心肌梗死.     

aVR导联对前壁心肌梗死相关血管定位的作用

目的通过与冠状动脉造影（CAG）对比，研究aVR导联ST段改变的特征。对急性前壁心肌梗死（AAMI）的梗死相关动脉（IRA）阻塞部位的定位。方法对比89例急性前壁心肌梗死病人．其中左前降支近段（PS）闭塞43例、左前降支远段（DS）闭塞46例，胸痛发作12h内的心电图。结果两组胸导联的ST段抬高无明显差异，PS组aVR导联ST段抬高较明显（0．94±0．48mmvs0．30±0．56mm．p=0．021）：PS组Ⅱ、Ⅲ、aVF导联ST段压低较显著（分别为-1．21±0．72mm vs S-0．64±0．53mm。p=0．010；-1．63±0．92mmvs-0．98＋0．39mm．／9=0．016；-1．40±0．66mm vs -0．85±0．32mm，／9=0．000）。在胸导联ST段抬高的同时．aVR导联ST段抬高预测左前降支（LAD）近段闭塞的敏感性（Se）、特异性（Sp）、符合率（CR）、阳性预测值（PPV）、阴性预测值（NPV）分别为60．47％、93．48％、77．53％、89．66％、71．67％。结论在胸导联ST段抬高的同时合并aVR导联ST段抬高和／或下壁导联的ST段压低，可预测左前降支近段闭塞。     

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。     

静息心电图在诊断冠状动脉病变中的作用

目的探讨常规12导联心电图指标对静息状态下冠状动脉病变的预测价值。方法回顾性分析1998年3月～2006年1月拟诊不稳定型心绞痛并行冠状动脉造影患者（104例）的造影资料及冠脉造影前心电图。以左主干、前降支、回旋支、右冠状动脉中任一支狭窄≥50％者为阳性，将患者分为阴性组（8例）、单支病变组（41例）、双支病变组（25例）、三支病变组（16例）、左主干病变组（14例，可合并单支、双支或三支病变）。各组病例的年龄、性别、化验检查等指标进行统计学分析；计数各组病例心电图aVR导联ST段抬高病例数、异常导联数、ST段移位绝对值之和、异常导联数＋ST段移位绝对值之和、ST段时间，在单支病变组、双支病变组、三支病变组和左主干组之间进行统计学分析。结果①年龄：单支病变组与左主干病变组比较有显著性差异（P〈0.05），其它各组间比较无显著性差异（p〉0．05）。（参avR导联ST段抬高、异常导联数、ST移位、异常导联＋ST段移位：单支病变组与三支病变组、左主干病变组之间比较有显著性差异（P〈0．05）；ST段改变时间：单支病变组与左主干病变组之间比较有显著性差异（p〈0.05），但与三支病变组比较无显著性差异（P〉0．05）。③aVR导联抬高、ST段移位、异常导联＋ST段移位：双支病变组与三支病变组、左主干组比较有显著性差异（p〈0．05）；异常导联，双支病变组与三支病变组、左主干病变组比较无显著性差异（p〉0．05）；ST段时间：双支病变组与左主干病变组比较有显著性差异（p〈0．05），而与三支病变组比较无显著性差异（p〉0．05）。结论aVR导联抬高、ST段移位、异常导联＋ST段移位是识别单支病变或双支病变与三支病变或左主干病变的敏感指标；ST段时间是识别单支病变或双支病变与左主干病变的敏感指标，但对识别三支病变不敏感；异常导联数对识别单支病变与三支病变或左主干病变敏感，但对识别双支病变与三支病变或左主干病变不敏感。     

aVR导联S T段抬高预测非S T段抬高型急性心肌梗死的临床价值

目的：探讨aVR导联ST段抬高对非ST段抬高型急性心肌梗死的预测价值。方法选取27例心电图改变为ST段压低≥0．1 mV伴aVR导联ST段抬高者作为观察组,另选50例ST段压低≥0．1 mV但不伴aVR导联ST段抬高者作为对照组,追踪观察2组非ST段抬高型急性心肌梗死的发生率。结果临床确诊为非 ST 段抬高型心肌梗死者观察组为7例（25．9％）,对照组为1例（2％）;2组比较差异有统计学意义（P＜0．05）。结论 aVR导联ST段抬高对非ST段抬高型急性心肌梗死具有一定的预测价值,临床应给予重视。     

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。     

常规心电图对急性前壁心肌梗死时前降支闭塞部位预测价值的临床研究

目的探讨急性前壁心肌梗死时的常规心电图（ECG）对前降支（LAD）闭塞部位的预测价值。方法根据冠状动脉造影的结果，以第一间隔支（S1）为标志将患者分为S1近端病变（PS）组（61例）和S1远端病变（DS）组（40例）。分别测量常规ECG12导联ST段的偏移程度及出现的频率，以计算、比较两组之间的差异及其对近、远段病变部位的预测性诊断价值。结果（1）各导联诊断LAD近端病变的敏感性和特异性分别为：aVR导联ST段抬高为43％和85％（P=0．004）；aVL导联ST段抬高≥1．5mm为16％和97％（P=0．031）；Ⅱ导联ST段下移≥1．0mm为39％和85％（P=0．009）；Ⅲ导联ST段下移≥2．0mm为23％和98％（P=0．005）；aVF导联ST段下移≥1．0mm为38％和88％（P=0．006）；V5导联ST段下移为20％和86％（P=0．037）；aVR导联ST段抬高同时伴V5导联ST段下移为18％和100％（P=0．005）；aVR导联ST段抬高同时伴V6导联ST段下移为30％和93％（P=0．008）；（2）各导联诊断LAD远端病变的敏感性和特异性分别为：Ⅲ导联ST段居于等电位线或抬高为53％和90％（P=0．000）；V5导联ST段抬高≥1．5mm为50％和82％（P=0．001）；（3）近、远端患者的梗死面积和心功能水平未见明显差异。结论（1）aVR导联ST段抬高同时出现V5、V6导联ST段下移；下壁导联Ⅱ、Ⅲ、aVF导联ST段明显下移（Ⅱ，aVF导联ST段下移≥1．0mm，STⅢ下移≥2．0mm）以及Ⅰ，aVL导联ST段抬高，尤其是aVL导联ST段抬高≥1．5mm均提示LAD近端病变。（2）下壁导联（尤其是Ⅲ导联）ST段居于等电位线或升高，V5导联ST段抬高≥1．5mm均提示LAD远端病变。     

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导联对急性下壁心肌梗死罪犯血管的预测价值

目的通过与冠状动脉造影（CAG）对比，研究aVR导联ST段改变的特征对急性下壁心肌梗死的相关动脉定位的意义。方法对比65例急性心肌梗死，其中右冠状动脉近段闭塞26例、右冠状动脉远段闭塞29例、左叫旋支（LCX）闭塞10例，分析在病人胸痛发作12h内的心电图变化。结果三组病人下壁导联的ST段抬高差异无统计学意义，伴aVR导联ST段压低，提示右冠状动脉（RCA）闭塞，如不伴aVR导!联卯段膻低，则提示LCX闭塞，右冠状动脉近段闭寒，不影响胸前导联ST段，心电图指标阳性预测值96．7％；右冠状动脉远段闭塞则构成V1～V3导联ST段压低，阳性预测值83％；LCX闭塞虽不影响aVR导联卯段，但构成V1～V3导联ST段压低，阳性预测值87％。结论急性下壁心肌梗死早期除下壁导联ST段抬高外，是否合并aVR导联ST段压低，是区别RCA闭塞或LCX闭塞的关键指标。对预后和决定是否采取血管厦建治疗具有重要的参考价值。     

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.     

STaVR抬高对急性冠状动脉综合征预后评估的价值

目的探讨心电图STaVR抬高对急性冠状动脉综合征预后评估的价值。方法回顾性分析68例急性冠状动脉综合征患者的心电图和冠状动脉造影资料、临床资料。根据STaVR抬高是否≥0.05mV分为抬高组（n=23）和非抬高组（n=45）。结果病变血管涉及左主干和左前降支近段的分别为抬高组13例（56.5％）和非抬高组1例（2.2％）,病变范围为多支病变的分别为9例（39.1％）和8例（17．8％）,发生心脏事件分别为7例（30.4％）和4例（8.9％）,两组差异均有非常显著性意义（P〈0．01）。结论急性冠状动脉综合征患者STaVR抬高提示左主干和左前降支近段病变、多支病变的可能,对判断预后有参考价值。     

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.     

Anterior ST-segment deviation during inferior myocardial infarction: arteriographic correlations during the acute phase

Electrocardiographic changes in the anterior wall lead in inferior myocardial infarction were studied in coronary angiographic findings in the acute stage. The subjects were 40 patients with initial inferior myocardial infarction due to right coronary lesions. ST segments were elevated in 7 patients, remained unchanged in 11 and were depressed in 22. Two patients predominantly perfused in the left coronary artery showed ST elevation. All seven patients who showed elevation of the ST segments had occlusion of the ventricular branch proximal to right. However, another 15 (68%) of the patients with occlusion of the same lesion did not show elevation of any ST segment. There was no difference in left ventricular ejection fraction between the groups. The regional ejection fraction at the left ventricular inferior wall was significantly (p less than 0.01) higher in the ST elevated group than in the ST depressed group. Elevation of the ST segments in the anterior wall lead was observed only when the right ventricular free wall sustained injury, and no elevation of any ST segment was observed when the range of injury in the inferoposterior wall was wide, even in the presence of injury to the right ventricular free wall.     

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.     

Value of lead aVR in the detection of significant left main coronary artery stenosis in acute coronary syndrome

BACKGROUND: Electrocardiographic lead aVR is usually ignored in patients with chest pain. ST segment elevation in aVR may have diagnostic value in patients with acute coronary syndrome (ACS) and significant stenosis or obstruction of the left main coronary artery (LMCAS), especially when accompanied by ST segment elevation in lead V(1). AIM: To asses the value of lead aVR and V1 for the detection of LMCAS in patients with ACS. METHODS: The study group consisted of 150 patients (mean age 60.6+/-9.5 years, range 33-78 years) with ACS, including 46 with LMCAS and 104 without LMCAS. ECG recordings obtained on admission were compared between these two groups. RESULTS: In patients with LMCAS, ST segment elevation in lead aVR was two times more frequent than in remaining patients (69.6% vs 34.6% p=0.0001) whereas there were no differences in lead V(1). Sensitivity of ST elevation in aVR in detection of LMCAS was 69.6%, specificity - 65.4%, positive predictive value - 47.1%, and negative predictive value - 82.9%. In patients with LMCAS, ST segment depression was significantly more often present in ECG leads other than aVR (45.6% vs 23.1% p<0.01). Patients with LMCAS more often had hypertension (95.6% vs 77.9% p<0.05) and three-vessel disease (78.3% vs 31.8%, p<0.0001). CONCLUSIONS: The assessment of lead aVR in patients with ACS may indicate LMCAS. Additional analysis of lead V(1) does not improve diagnostic accuracy.     

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。