Madias J E, Ashtiani R, Agarwal H, Win M, Narayan V K, Sinha A
Zena and Michael Wiener Cardiovascular Institute, Mount Sinai/New York University Medical Center Health System, New York, NY, USA.
J Electrocardiol. 2001 Apr;34(2):147-54. doi: 10.1054/jelc.2001.23357.
An analysis of the 4,196 files of our Cardiology Clinic cohort showed 128 patients with a complete left bundle branch block (LBBB) in their electrocardiograms (ECGs). Of these patients, 27 had suffered a myocardial infarction in the past and had been found to have a ventricular aneurysm (VA), documented by > or = 1 of several noninvasive and invasive diagnostic methods. Five of these 27 patients had stable ST-segment elevation in > or = 1 of left precordial ECG leads, with predominantly positive QRS complexes (an ECG criterion for the diagnosis of VA in the presence of LBBB, which we have recently described). The sensitivity of this ECG criterion for the diagnosis of VA was 18.5%, and the specificity was 100%. The frequency of distribution of VA in the septal, and even more, apical myocardial regions was higher in the patients with a positive ECG diagnosis of VA, than in the patients with a negative one (P = .049, and P = .009, correspondingly). The number of myocardial territories involved with a VA was not different in the 2 subgroups (P =.325). Pathophysiologically, this ECG alteration diagnostic of VA represents a superimposition of the primary ST-segment elevation due to the VA, on the expected secondary ST-segment depression due to the LBBB, and represents a summation effect.
对我们心脏病诊所队列中的4196份病历进行分析后发现，128例患者的心电图（ECG）显示完全性左束支传导阻滞（LBBB）。在这些患者中，27例过去曾发生心肌梗死，并通过几种非侵入性和侵入性诊断方法中的至少一种确诊患有室壁瘤（VA）。这27例患者中有5例在左胸前导联中的至少1个导联出现稳定的ST段抬高，QRS波群主要为正向（这是我们最近描述的在存在LBBB时诊断VA的心电图标准）。该心电图标准诊断VA的敏感性为18.5%，特异性为100%。心电图诊断VA呈阳性的患者中，VA在间隔心肌区域甚至心尖心肌区域的分布频率高于诊断呈阴性的患者（相应地，P = 0.049和P = 0.009）。两个亚组中涉及VA的心肌区域数量没有差异（P = 0.325）。从病理生理学角度来看，这种诊断VA的心电图改变代表了由于VA导致的原发性ST段抬高叠加在由于LBBB预期出现的继发性ST段压低上，表现为一种叠加效应。
