aVR导联对急性心肌梗死相关血管病变的研究

目的探讨急性心肌梗死时心电图aVR导联QRS波群形态与冠状动脉造影梗死相关血管病变的对比分析。方法对45例急性下壁心肌梗死组、78例急性前壁心肌梗死组和80例对照组的心电图AVR导联QRS波群形态变化与冠状动脉造影(CAG)相关血管病变进行对比分析。结果 45例急性下壁心肌梗死患者组aVR导联QRS波群呈rs(S)型共计77.77%,80例对照组aVR导联QRS波群呈rs(S)型1.25%,P<0.01。Ⅰ、aVR导联的ST段抬高≥0.1mV时78例急性前壁心肌梗死患者组中为66.66%,对照组为6.25%,P<0.01;而Ⅱ、Ⅲ、aVF导联的ST段压低≥0.05mV时前者74.35%,后者18.75%,P<0.01。相关血管病变比较:45例下壁心肌梗死aVR导联ST段抬高伴Ⅱ、Ⅲ>Ⅰ、aVL导联ST段压低,冠脉造影为右冠状动脉(RCA)病变55.55%,aVR导联ST段压低≥0.1 mV为左前降支(LAD)病变44.44%。78例急性前壁心肌梗死aVR导联ST段抬高≥0.1 mV,冠脉造影为左主干(LM)病变51.28%,LM+RCA(右冠状动脉)病变48.71%,两组比较差异无统计学意义,P>0.05。80例对照组均无冠状动脉病变,与前两者无可比性。结论急性下壁心肌梗死后心电图aVR导联QRS波群多呈rs(S)型伴ST段抬高为右冠状动脉(RCA)病变,伴aVR导联ST段压低为左前降支(LAD)病变;急性前壁心肌梗死伴aVR导联ST段抬高以左主干(LM)病变为主。

Role of aVR Lead in Diagnosis of Vessel Lesion Related to Acute Myocardial Infarction

Objective To investigate the relationships between the variation of QRS wave in electrocardiogram aVR lead and the imaging of coronary angiography(CAG) in patients with acute myocardial infarction.Methods Forty five patients with acute inferior myocardial infarction,seventy-eight patients with acute anterior myocardial infarction and eighty normal subjects were enrolled in this study.The changes of QRS wave in electrocardiogram aVR lead and the imaging of CAG were analyzed and compared.Results The rs(S) pattern accounted for 77.77% of the QRS complex of aVR lead in the acute inferior myocardial infarction group,and for 1.25% in the control group,P<0.01.ST segment elevation≥0.1 mV in Ⅰ and aVR leads accounted for 66.66% in the acute anterior myocardial infarction group,and for 6.25% in the control group,P<0.01.ST segment depressed≥0.05 mV in Ⅱ,Ⅲ and aVF leads accounted for 74.35% in the acute anterior myocardial infarction group,and for 18.75% in the control group,P<0.01.In the acute inferior myocardial infarction group,when ST segment elevation in aVR lead combined with ST segment depression in Ⅱ,Ⅲ and aVL leads,CAG showed that right coronary artery(RCA) lesion accounted for 55.55%;when the aVR Lead ST segment depressed≥0.1 mV the left anterior descending artery(LAD) lesion accounted for 44.44%.In the acute anterior myocardial infarction group,when aVR lead ST segment elevation≥0.1 mV,CAG showed that left main coronary artery(LM) lesion accounted for 51.28%,LM+RCA lesion for 48.71%,the difference had no significantly difference,P>0.05.No coronary artery lesion was found in the control group.Conclusion The rs(S) pattern and ST segment elevation frequently present in aVR in electrocardiogram of acute inferior myocardial infarction patients with right coronary artery(RCA) lesion,and aVR lead ST segment depressed show left anterior descending artery(LAD) lesion;ST segment elevation in lead aVR is the indicator lesion of left main coronary artery(LM) in acute anterior myocardial infarction.