急性下壁心肌梗死侧壁导联心电图“镜像”改变对梗死相关动脉的预测价值

目的　分析急性下壁心肌梗死侧壁导联 (I、AVL)心电图呈“镜像”改变对梗死相关动脉的预测价值。方法　根据 86例急性下壁心肌梗死患者侧壁导联心电图有无“镜像”改变 ,对比其与冠状动脉造影显示梗死相关动脉的关系。结果　I,AVL导联出现“镜像”改变对判断急性下壁心肌梗死梗死相关动脉为右冠状动脉的敏感性分别为 6 3.0 %和94 .5 % (P <0 .0 5 ) ,特异性分别为 76 .9%和 6 1.5 % (P <0 .0 5 )。AVL导联无“镜像”改变对判断梗死相关动脉为左回旋支的阳性预测值为 6 6 .7% ,阴性预测值为 93.2 %。结论　急性下壁心肌梗死I和AVL导联呈“镜像”改变是判断梗死相关动脉为右冠状动脉的较敏感指标 ,尤以AVL导联更敏感。AVL导联无“镜像”改变是判断梗死相关动脉为左回旋支的较好指标。     

急性下壁心肌梗死的相关动脉与体表心电图改变的关系

目的　对 5 0例急性下壁心肌梗死患者的心电图进行分析并与冠状动脉造影的结果进行比较 ,以揭示体表心电图对梗死相关动脉的预测价值。　方法　根据冠状动脉造影的结果将 5 0例急性下壁心肌梗死患者分为 3组 :右冠状动脉 (right coronary artery,RCA)闭塞组 2 4例 ,左回旋支 (left cir-cum flex artery,L CX)闭塞组 17例 ,右冠状动脉及左回旋支 (RCA L CX)同时闭塞组 9例。结果　 (1)RCA组 ST 抬高 >ST 抬高的发生率明显高于 L CX组及 RCA L CX组 (P<0 .0 0 5 ) ,灵敏度、特异度、诊断符合率、阳性预测值及阴性预测值分别为 87.5 %、84.6 %、86 %、84%、86 % ;L CX组与 RCA L CX组后壁导联梗死图形的发生率明显高于 RCA组 (P<0 .0 0 5 ) ,阴性预测值分别为 84.6 %、10 0 % ;RCA组及 RCA L CX组右心室梗死的发生率明显高于 L CX组 (P<0 .0 1) ;(2 ) RCA组及 RCA L CX组侧壁导联 ST段下移的发生率及 STa VL下移 >STI 下移的发生率明显高于 L CX组 (P<0 .0 0 5～ 0 .0 5 ) ,其中a VL 导联 ST段下移及 STa VL 下移 >STI 下移对各自梗死相关动脉的阴性预测值分别为 76 .2 %、90 .5 %、73.3%、83.3% ;L CX组前壁导联 ST段下移的发生率明显高于 RCA组及 RCA L CX组 (P<0 .0 0 5～ 0 .0 5 ) ,其灵敏度、特     

Consideration of the total ST-segment deviation on the initial electrocardiogram for predicting final acute posterior myocardial infarct size in patients with maximum ST-segment deviation as depression in leads V1 through V3. A FRISC II substudy

BACKGROUND: Because patients with acute left circumflex occlusion are typically characterized primarily on the standard 12-lead electrocardiogram (ECG) by ST depression, they do not qualify to receive reperfusion therapy. Documentation of a relationship between the quantities of acute ST change and final QRS estimated acute myocardial infarction (AMI) size could form the basis for clinical trials to determine the value of reperfusion therapy. METHOD: The Fragmin and Fast Revascularization during Instability in Coronary artery disease trial included 3214 patients with unstable coronary artery disease. Two percent of the patients (n = 69) had maximum ST-segment depression in leads V 1 through V 3 and were selected for this study. Initial ECG changes were compared to final myocardial infarction size, using the Selvester QRS score as the end point. RESULTS: The quantity of initial ST-segment deviation correlated with the final AMI size (r = 0.43, P < .0005). The formula 3[0.22 (SigmaST downward arrow + SigmaST upward arrow) -0.02], where downward arrow indicates depression and upward arrow elevation, derived from measurements on the initial ECG, predicted the size of the AMI in percentage of the left ventricle as estimated on the final ECG. The study population had a large proportion of AMI (73%) indicated to be in or adjacent to the posterior left ventricular wall. CONCLUSION: The quantitative initial ST-segment deviation correlates linearly to the final AMI size in patients with maximum ST-segment depression in leads V 1 through V 3. The formula derived could be valuable for selecting patients who fail to meet strict ST-elevation AMI criteria for emergency intravenous or intracoronary reperfusion therapy.     

急性心肌梗死患者早期心电图改变与临床的相关研究

目的　探讨急性心肌梗死 (AMI)患者早期心电图 (ECG)梗死面积大小 ,ΣST↑ ,QTc离散度与左心衰竭、心源性休克、室性心律失常等并发症的关系 ,以探讨心电图对AMI的诊断价值。方法　 188例AMI患者发病 4 8h内的心电图与临床心脏事件进行对比分析。结果　①QRS积分≥ 7组并发症发生率与病死率均高于QRS积分 <7组 ,P<0 0 5 ;②死亡组 15例平均ΣST↑为 (15 4± 10 9)mm ,存活组 173例为 (10 7± 7 9)mm ,P <0 0 5 ;③室性心律失常组与无室性心律失常组Q -Tcd分别为 (71 37± 9 5 1)ms、(4 9 11± 16 2 4 )ms ,P <0 0 5。结论　早期心电图改变对AMI患者的心功能有密切关系 ,对预后的评估有一定的意义 ,可作为临床诊断的重要参考依据。     

体表心电图预测下壁心肌梗塞的梗塞相关动脉

目的 探讨下壁急性心肌梗塞的初始心电图能否预测梗塞相关动脉(IRA)以及合并存在的冠状动脉病变是否会改变这种预测能力.方法 102例下壁AMI病人在入院时记录标准十二导联心电图的ST段移位情况,并在住院期间行冠状动脉造影确定IRA,分析心电图ST移位与梗塞相关动脉的关系.结果(1)双左回旋支(LCX)为IRA的病人和以右冠状动脉(RC)为IRA的病人相比,前者V_1或V_2导联ST段压低的发生率明显高于后者(分别为80%和43%,P<0.01),前者I导联ST段抬高或位于等电位线的发生率也高于后者(分别为63%和27%,P<0.05);(2)根据V_1或V_2导联ST段压低判断LCX为IRA的敏感性、特异性和阴性预测值分别为83%、56%和93%.结论 下壁AMI时V_1或V_2导联ST段压低是判断LCX作为IRA敏感指标,并具有很高的阴性预测值,合并存在的冠状动脉病变不会改变这种预测能力.     

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。     

Consideration of QRS complex in addition to ST-segment abnormalities in the estimation of the “risk region” during acute anterior or inferior myocardial infarction

The myocardial area at risk (MaR) is an important aspect in acute ST-elevation myocardial infarction (STEMI). It represents the myocardium at the onset of the STEMI that is ischemic and could become infarcted if no reperfusion occurs. The MaR, therefore, has clinical value because it gives an indication of the amount of myocardium that could potentially be salvaged by rapid reperfusion therapy. The most validated method for measuring the MaR is ^99mTc-sestamibi SPECT, but this technique is not easily applied in the clinical setting. Another method that can be used for measuring the MaR is the standard ECG-based scoring system, Aldrich ST score, which is more easily applied. This ECG-based scoring system can be used to estimate the extent of acute ischemia for anterior or inferior left ventricular locations, by considering quantitative changes in the ST-segment. Deviations in the ST-segment baseline that occur following an acute coronary occlusion represent the ischemic changes in the transmurally ischemic myocardium. In most instances however, the ECG is not available at the very first moments of STEMI and as times passes the ischemic myocardium becomes necrotic with regression of the ST-segment deviation along with progressive changes of the QRS complex. Thus over the time course of the acute event, the Aldrich ST score would be expected to progressively underestimate the MaR, as was seen in studies with SPECT as gold standard; anterior STEMI (r = 0.21, p = 0.32) and inferior STEMI (r = 0.17, p = 0.36). Another standard ECG-based scoring system is the Selvester QRS score, which can be used to estimate the final infarct size by considering the quantitative changes in the QRS complex. Therefore, additional consideration of the Selvester QRS score in the acute phase could potentially provide the “component” of infarcted myocardium that is missing when the Aldrich ST score alone is used to determine the MaR in the acute phase, as was seen in studies with SPECT as gold standard: anterior STEMI (r = 0.47, p = 0.02) and inferior STEMI (r = 0.58, p < 0.001). The aim of this review will be to discuss the findings regarding the combining of the Aldrich ST score and initial Selvester QRS score in determining the MaR at the onset of the event in acute anterior or inferior ST-elevation myocardial infarction.     

急性心肌梗死对应导联ST段变化与冠状动脉病变的关系

目的 用冠状动脉造影技术研究急性心肌梗死(AMI)对应导联ST段变化与冠状动脉病变的关系。方法136例急性心肌梗死共分五组:①组,前壁梗死(V1-6)伴有Ⅱ,Ⅲ,aVF导联ST段下移。②组,下壁梗死(Ⅱ,Ⅲ,aVF)同时伴有V1-6导联ST段下移。③组,下壁梗死(Ⅱ,Ⅲ,aVF)同时伴有I,aVL导联ST段下移。④组,前壁梗死(V1-6)未伴有其它导联的ST段变化。⑤组,下壁梗死(Ⅱ,Ⅲ,aVF)未伴有其它导联的ST段变化。所有患者均进行冠状动脉造影。结果 前壁心肌梗死伴有Ⅱ,Ⅲ,aVF导联ST段下移25例中有88%为左冠状动脉前降支病变,其中90.9%为左冠状动脉近端病变。前壁心肌梗死未伴有Ⅱ,Ⅲ,aVF导联ST段下移的36例患者中有94.4%为左冠状动脉前降支病变,两者统计无显著性差异。在下壁心肌梗死伴有V1-6导联ST段下移组22例中有81.8%为右冠状动脉病变,但同时伴有前降支病变的却有77.3%,其中单支病变仅18.2%。下壁心肌梗死未伴有V1-6导联ST段下移34例有91.2%为右冠状动脉病变,但同时伴有前降支病变的仅有32.4%,其中单支病变达52.9%。两组统计分别为P<0.001和P相似文献   

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。     

急性心肌梗死直接PCI后心电图ST段回落幅度与血管内皮功能的关系

目的:探讨急性心肌梗死(AMI)直接经皮冠状动脉介入术(PCI)后心电图ST段回落幅度与血管内皮功能的关系。方法:AMI直接PCI后梗死相关血管(IRA)血流达TIMI3级患者51例,按ST段回落幅度分为A组32例(ST段迅速回落组)和B组19例(ST段持续抬高组)。所有患者于发病(7±2)d和3个月测量肱动脉流量介导舒张(FMD)和硝酸甘油介导舒张(NMD)。正常对照组25例。结果:AMI发病1周时A组和B组FMD(5·42%±2·27%与1·99%±1·63%,P<0·05)和NMD(15·08%±8·79%与6·84%±3·92%,P<0·05)均明显低于正常对照组(FMD9·60%±3·41%,NMD22·17%±8·49%);AMI发病后3个月A、B2组的FMD(9·06%±1·98%与5·44%±1·91%,P<0·01)和NMD(20·90%±5·78%与12·93%±4·71%,P<0·01)均较基础状态增加,A组内皮功能基本恢复正常,B组虽然有恢复但未达到正常状况。结论:AMI血管内皮功能明显受损,成功再灌注后ST段持续抬高的患者受损更明显。随着时间的延长内皮功能有所恢复,ST段持续抬高的患者恢复差于ST段迅速回落者。     

急性心肌梗死时血清镁与心律失常关系的探讨

目的　探讨急性心肌梗死时血清镁与心律失常的关系。方法　回顾性分析１１２ 名ＡＭＩ患者于入院７２ 小时内行持续心电监护及心电图检查,并测血清镁。结果　心律失常组６１ 人中低镁血症４４ 人,心律正常组５１ 人中低镁血症１３ 人,两组有显著差别（ Ｐ＜ ０－０１） ,两组平均血镁浓度间亦有显著差异（ Ｐ＜ ０－０１） 。经补镁治疗的低血镁心律失常患者预后优于未予补镁者（ Ｐ＜ ０－０５） 。结论　ＡＭＩ并低镁血症比血镁正常者更易出现心律失常,早期监测血镁、及时补镁有利于心律失常的防治。     

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。     

急性前壁心肌梗死下壁导联ST段压低的临床价值

目的 探讨急性前壁透壁性心肌梗死时下壁导联ST段压低的临床价值。方法 比较任一下壁导联ST段压低≥1.0mm的17例与压低均＜1．0mm的16例的CK－MB值、超声心动描记术、冠状动脉造影等结果。结果 前组CK－MB值更高,射血分数减低更显著,左室收缩与舒张末期容积更大,造影术示致梗死狭窄病变多位于左前降支近端或呈多支病变。结论 急性前壁心肌梗死下壁导联ST段压低≥1.0mm时,其梗死面积较大,会发生较严重的左室射血功能损害及左心室重构。     

急性下壁心肌梗死的房室传导阻滞及其罪犯血管

房室传导阻滞是急性下壁心肌梗死的常见并发症,而左、右冠状动脉病变均可导致下壁心肌梗死。由于心脏冠状动脉供血至心肌的部位及范围不同,因此其病变导致的心肌梗死的程度与范围也不尽相同,相应地可产生不同的心电图表现。丰富的临床经验和心电图知识有助于判断冠状动脉罪犯血管并确定其闭塞部位（近端、中端或远端）,也有助于制定合理的紧急再灌注治疗方案,挽救患者生命。     

三种体表心电图指标对判断急性下壁心肌梗死时心肌梗死相关动脉的意义

目的探讨急性下壁心肌梗死时三种体表心电图指标对判断心肌梗死相关动脉的意义.方法对120例急性下壁心肌梗死患者的三种体表心电图指标和冠状动脉造影资料进行对比分析.结果(1)心肌梗死相关动脉为右冠状动脉共98例(81.7%),左回旋支22例(18.3%).(2)Ⅰ导联ST段有压低提示右冠状动脉闭塞的敏感性为77.6%,特异性为90.9%,Ⅰ导联ST段无压低提示左回旋支闭塞的特异性为77.6%,敏感性为90.9%,故Ⅰ导联有无ST段压低可作为判断下壁心肌梗死相关动脉的一个指标.(3)aVL导联S/R≥1/3对于预测RCA为下壁心肌梗死相关血管的敏感性为93.9%,特异性为63.6%.(4)右冠状动脉无论是近段、中段和远段的病变,ST段抬高幅度Ⅲ≥Ⅱ导联的病例数与非Ⅲ≥Ⅱ导联的病例数存在显著差异,而左冠状动脉回旋支组无显著差异.结论导联ST段压低、aVL导联QRS波群以及Ⅲ和Ⅱ导联ST段抬高幅度的不同变化对判断下壁心肌梗死相关血管有重要的预测意义.     

急性重症病毒性心肌炎与急性心肌梗死的临床比较

目的探讨急性重症病毒性心肌炎与急性心肌梗死（AMI）在临床和心电学特征的异同。方法对10例急性重症病毒性心肌炎及24例急性心肌梗死患者的临床、心肌酶谱与心电学演变特征进行分析。结果重症病毒性心肌炎与急性心肌梗死的区别为：①常见于青壮年，发病前或发病时常有呼吸道、消化道感染史，且常伴发热，三度房室传导阻滞及阿-斯综合征发生率较高，而胸痛发生率低，相对较轻甚至无胸痛。②心肌酶谱升高相对不显著（一般呈轻～中度升高），尤其是CK—MB甚至可在正常范围，心肌酶峰不显著，CK峰值、CK-MB峰值及CK峰值／ST段抬高导联数比值、CK—MB峰值／ST段抬高导联数比值均明显低于急性心肌梗死组（P均〈0．01）。③心电图损伤性改变显著，病理性Q波常呈-过性可逆性改变，多数呈QS或QR型，经适当治疗一般2-3天内消失；而急性心肌梗死组多数呈qR型，且病理性Q波逐渐增深、加宽、范围扩大或出现等电位性Q波。④ST段抬高和无对应性ST段压低。⑤病理性Q波与ST段抬高发生的导联“不吻合”，且不能用某支冠状动脉阻塞来解释心电图改变。结论急性重症病毒性心肌炎与急性心肌梗死可根据临床、心肌酶谱和心电学演变等特征，作出鉴别诊断。     

心电图在判定急性下壁心肌梗死犯罪血管

目的评定心电图在判定急性下壁心肌梗死罪犯血管的意义。方法对５６例急性下壁心肌梗死患的心电图及冠状动脉造影资料进行分析。结果①罪犯血管是右冠状动脉占８５．７％,回旋支占１４．３％;②窦性心动过缓、房室传导阻滞、室颤是右冠状动脉闭塞指标;③ＳＴＩ．ａＶＬ压低≥１．０ｍｍ是右冠状动脉闭塞敏感指标（Ｐ＜０．０５及Ｐ＜０．０１）,敏感性及特异性分别为６９％、７５％及９２％、７５％,而缺乏ＳＴＩ．ａＶＬ压低     

急性ST段抬高心肌梗死直接经皮冠脉介入治疗对QT离散度的影响

目的 探讨直接经皮冠脉介入治疗(PCI)对急性ST段抬高心肌梗死患者QT离散度(QTd)的影响。方法 选择48例成功实施了直接PCI术的急性ST段抬高心肌梗死患者为治疗组，选择6例直接急诊PCI术失败未能行早期再灌注的急性ST段抬高心肌梗死患者为对照组，分别记录术前半小时与术后即刻、术后3小时、术后6小时、术后24小时、第3天、第7天的十二导联心电图，计算各时期的QTd。结果 急性ST段抬高心肌梗死直接PCI治疗后6小时QTd即明显下降(P＜0．01)，术后24小时下降至高峰，此后维持稳定。治疗组术后6小时以后QTd较对照组有显著下降(P＜0．01)。结论 直接PCI术治疗急性ST段抬高心肌梗死，可使患者QTd明显缩短。     

Bundle branch block in acute Q wave inferior wall myocardial infarction: A high risk subgroup of inferior myocardial infarction patients

The aim of this study was to determine the incidence and impactof right and left bundle branch block on the in-hospital, 5-yearand 10-year mortality of patients with acute inferior Q wavemyocardial infarction. A retrospective analysis of clinicalcharacteristics, hospital, 1-, 5-, and 10-year mortality of2215 consecutive patients with acute inferior Q wave myocardialinfarction hospitalized in 13 coronary care units in Israelwas performed Bundle branch block during acute Q wave inferior wall myocardialinfarction was present in 108 patients (4.9%), 85 of whom hadright and 23 left bundle branch block. Patients with bundlebranch block had more in-hospital complications than those without,irrespective of the site and time of appearance of the block.In addition, a trial fibrillation (19%), complete atrioventricularblock (21%) and congestive heart failure (45%) appeared morefrequently in patients with, than in those without, bundle branchblock (11%, 9% and 31%, respectively), and in-hospital and 5-yearmortality were higher in patients with the block (22%, 33%)than in those without it (13% and 23%, respectively). Bundle branch block emerged as an independent predictor of deathonly among patients with new right bundle branch block, andright bundle branch block emerged as an independent predictorfor the development of complete atrioventricular block (oddsratio 2.13; 90% confidence interval 1.39–3.28). However,hospital mortality among patients with inferior myocardial infarctionand complete atrioventricular block was virtually independentof bundle branch block (39% with vs 36% without bundle branchblock, respectively). Patients with inferior Q wave myocardial infarction and bundlebranch block comprise a high risk subgroup of patients witha complicated hospital course and increased hospital and long-termmortality.     

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.