[右胸导联在提高心肌缺血检测准确性中的作用]

[Role of the right chest lead in improving the accuracy of myocardial ischemia detection].

作者信息

Wierzbowska Karina, Kurpesa Małgorzata, Peruga Jan, Drozdz Jarosław, Krzemińska-Pakuła Maria, Kasprzak Jarosław

机构信息

Klinika Kardiologii Instytutu Medycyny Wewnetrznej Akademii Medycznej w Łodzi.

出版信息

Przegl Lek. 2002;59(9):684-6.

PMID:12632885

Abstract

BACKGROUND

The limitations of exercise electrocardiography in the detection of coronary artery disease includes low sensitivity, especially in isolated right coronary artery (RCA) disease. Recent studies postulated the addition of right precordial leads to the standard exercise ECG (ExT) recording for better detection of right ventricular ischemia.

PURPOSE

We tested the hypothesis that the replacement of the standard first precordial lead (V1) with a fourth right chest lead (V4R) can improve the diagnostic accuracy of ExT.

MATERIALS AND METHODS

We studied 100 patients (78 men and 22 women, aged 55 +/- 9 years (31-71)) who underwent treadmill ExT (Bruce protocol) and coronary angiography. 52 patients had the V4R lead (Group V4R) instead of V1. The control group (Group V1) included 48 patients with the standard 12-lead ECG. Hemodynamically significant lesions were defined as stenosis > = 50% in left main coronary artery or > = 70% in other arteries.

RESULTS

76 out of 100 patients had significant coronary lesions on the arteriogram, 81% in Group V4R and 71% in Group V1. Overall sensitivity (71% Group V4R vs 79% Group V1), specificity (40% Group V4R vs 21% Group V1) and accuracy (65% Group V4R vs 63% Group V1) of ExT for detection of significant coronary artery disease was similar in both groups. There was also no statistically significant difference in the ability to define an inferior or right ventricle vs. anterolateral ischemia between both groups. Only 5 out of 32 (16%) patients with significant lesions in RCA revealed ST changes in V4R.

CONCLUSIONS

In our study, the application of V4R instead of V1 did not significantly change the accuracy of ExT. Typical ECG signs of ischemia in V4R have high specificity, but low sensitivity for RCA disease. Thus, modification of the standard 12-lead scheme cannot be advocated for routine ExT, however although the use of a wider electrocardiographic window (e.g. V3R-V5R) might be more successful for recording right ventricular ischemia.

摘要

背景

运动心电图在检测冠状动脉疾病方面存在局限性，包括敏感性较低，尤其是在孤立性右冠状动脉（RCA）疾病中。最近的研究推测，在标准运动心电图（ExT）记录中增加右胸前导联可更好地检测右心室缺血。

目的

我们检验了用第四右胸导联（V4R）替代标准第一胸前导联（V1）可提高ExT诊断准确性的假设。

材料与方法

我们研究了100例患者（78例男性和22例女性，年龄55±9岁（31 - 71岁）），这些患者接受了平板运动ExT（Bruce方案）和冠状动脉造影。52例患者使用V4R导联（V4R组）而非V1导联。对照组（V1组）包括48例采用标准12导联心电图的患者。血流动力学显著病变定义为左主干冠状动脉狭窄≥50%或其他动脉狭窄≥70%。

结果

100例患者中有76例在动脉造影上有显著冠状动脉病变，V4R组为81%，V1组为71%。ExT检测显著冠状动脉疾病的总体敏感性（V4R组为71%，V1组为79%）、特异性（V4R组为40%，V1组为21%）和准确性（V4R组为65%，V1组为63%）在两组中相似。两组在定义下壁或右心室与前侧壁缺血的能力方面也无统计学显著差异。在RCA有显著病变的32例患者中，只有5例（16%）在V4R导联出现ST段改变。