不稳定性心绞痛心电图预测左前降支病变部位的价值

目的 探讨12导联常规心电图表现在预测冠状动脉(冠脉)左前降支(LAD)病变部位中的价值.方法 选择临床诊断为不稳定性心绞痛(UAP)患者70例,冠脉造影结果显示罪犯血管为LAD.入院后完成12导联常规心电图检查,监测心肌损伤标志物变化,择期行冠脉造影术.分析UAP患者胸痛时心电图表现与LAD病变部位的关系.结果 96.7%的LAD近段狭窄患者,V3导联ST段压低伴V1、V2导联T波低平或倒置;7.5%的LAD中段狭窄患者,V3导联有相同改变(P＜0.05).V4导联ST-T段改变差异有显著性(P＜0.05);V5、V6导联ST-T段改变差异无显著性(P＞0.05).经多因素logistic回归分析显示,V3导联ST段压低是否伴V1、V2导联T波低平或倒置对LAD病变部位有明显的独立预测价值OR(95%CI)为33.119),P＜0.001].结论 UAP患者胸痛时,12导联常规心电图表现可以用于初步判定LAD近段或中段狭窄部位.

Study on the predictive value of 12-lead electrocardiogram in determine the pathological location of LAD

Objective To investigate the predictive value of 12-lead electrocardiogram in determining the pathological location of LAD.Methods Standard 12 leads ECG were recorded in 70 hospitalized patients with UAP from January 2003to March 2006.Coronary angiography indicated that the encroach vessel was LAD.All patients were examined by ECG.Meanwhile,myocardium lesion marker were supervised and coronary angiography were performed.Finally we analyzed the relationship between the ECG results of chest pain and the pathological location of LAD.Results In 96.7% patients of LAD proximal stenosis,ST segment of V_3 lead was depressed and T waves inversion of V_1 V_2 lead were observed.While 7.5% patients of LAD middle stenosis have the same result (P<0.05).ST-T segment of V_4 lead changed significantly(P<0.05),but ST-T segment of V_5 V_6 leads did not(P>0.05).ST segment depression of V_3 lead with or without T wave change can predicate the pathological location of LAD independtlyOR(95% CI):33.119,P<0.001].Conclusion The results of ECG during chest pain can determine the pathological location of LAD initially.