单支前壁心肌梗死后梗死相关病变残余狭窄的严重程度及左心室功能：入院心电图aVL导联ST段抬高的意义

Severity of residual stenosis of infarct-related lesion and left ventricular function after single-vessel anterior wall myocardial infarction: implication of ST-segment elevation in lead aVL of the admission electrocardiograms.

作者信息

Yoshino H, Kachi E, Shimizu H, Taniuchi M, Yano K, Udagawa H, Kajiwara T, Shimoyama K, Ishikawa K

机构信息

Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.

出版信息

Clin Cardiol. 2000 Mar;23(3):175-80. doi: 10.1002/clc.4960230309.

DOI:10.1002/clc.4960230309

PMID:10761805

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6654902/

Abstract

BACKGROUND

The relationship between the severity of chronic-phase stenosis of infarct-related lesions (IRLs) and chronic left ventricular function in anterior acute myocardial infarctions (AMI) has not been adequately investigated.

HYPOTHESIS

This study investigated whether ST elevation in lead aVL of admission electrocardiogram (ECG) would be a determinant factor of the relationship between the severity of stenosis of the IRL and chronic left ventricular function after anterior wall AMI.

METHODS

One month after AMI, the IRL was evaluated by coronary angiography in 98 patients with anterior AMI, and left ventricular ejection fraction (LVEF) was determined using multigated radionuclide angiocardiography. Patients were classified according to the severity of the IRL: patients with 100% occlusion (Group O), patients with 90 to 99% stenosis (Group H), and patients with < or =75% stenosis (Group L). Patients with ST elevation > or =0.1 mV in the aVL lead on their admission ECG were included in the ST-elevation group, and those with ST elevation <0.1 mV were included in the non-ST-elevation group.

RESULTS

The LVEF was greater in the non-ST-elevation group than in the ST-elevation group (p<0.0001), and the LVEF in a whole group as follows: Group L LVEF>Group H LVEF>Group O LVEF (p = 0.0160). In the ST-elevation group, LVEF was higher in Group L than in the other groups (p = 0.0251). There were three independent predictors of a reduced LVEF: ST-elevation in aVL [odds ratio (OR): 3.38, p = 0.0044], IRL stenosis > or =90% (OR: 2.90, p = 0.0044), and the IRL occurring in the left anterior descending artery proximal to the first diagonal branch (OR: 6.31, p = 0.0024).

CONCLUSION

Left ventricular function was preserved, regardless of the severity of residual stenosis, in patients without ST elevation in aVL if the IRL was not totally occluded. In patients with ST elevation in aVL, LVEF was lower in patients with more severe stenosis, even if the IRL was patent.

摘要

背景

梗死相关病变（IRL）慢性期狭窄的严重程度与前壁急性心肌梗死（AMI）后慢性左心室功能之间的关系尚未得到充分研究。

假设

本研究调查入院心电图（ECG）aVL导联ST段抬高是否是前壁AMI后IRL狭窄严重程度与慢性左心室功能之间关系的决定因素。

方法

AMI后1个月，对98例前壁AMI患者进行冠状动脉造影评估IRL，并使用多门控放射性核素心血管造影测定左心室射血分数（LVEF）。根据IRL的严重程度对患者进行分类：100%闭塞患者（O组）、90%至99%狭窄患者（H组）和≤75%狭窄患者（L组）。入院ECG aVL导联ST段抬高≥0.1 mV的患者纳入ST段抬高组，ST段抬高＜0.1 mV的患者纳入非ST段抬高组。

结果

非ST段抬高组的LVEF高于ST段抬高组（p＜0.0001），全组LVEF情况如下：L组LVEF＞H组LVEF＞O组LVEF（p = 0.0160）。在ST段抬高组中，L组的LVEF高于其他组（p = 0.0251）。LVEF降低有三个独立预测因素：aVL导联ST段抬高[比值比（OR）：3.38，p = 0.0044]、IRL狭窄≥90%（OR：2.90，p = 0.0044）以及IRL发生在第一对角支近端的左前降支（OR：6.31，p = 0.0024）。