Phillips H R, Starr J W, Behar V S, Walston A, Greenfield J C, Wagner G S
Circulation. 1976 Feb;53(2):235-40. doi: 10.1161/01.cir.53.2.235.
Vectorcardiograms (VCG) from a consecutive group of 77 patients with significant aortic valve disease were analyzed. All of the patients had complete left and right heart catheterization with normal coronary arteriograms and normal left ventricular contraction. Thirty-five (46%) patients met VCG criteria for anterior myocardial infarction (AMI-35%) and/or inferior myocardial infarction (IMI-14%). This was a significant increase in false positive diagnosis for both criteria compared to a group of 200 normal volunteers under age 30 and 100 patients with normal hearts by cardiac catheterization (P less than 0.01). It was found that if the VCG diagnosis of myocardial infarction was deferred when the maximal transverse plane magnitude was greater than 1.9 mV, the incidence of AMI false positive diagnosis decreased to 3% and the incidence of IMI false positive diagnosis decreased to 1%. The same rule was applied to the aortic valve disease cohort, a group of 124 patients with documented AMI and a group of 158 patients with IMI. This decreased the sensitivity of the AMI criteria from 93 to 83% and of the IMI criteria from 85 to 77%. The increase in average performance was statistically significant fro the AMI criteria (P less than 0.05) but not for the IMI criteria.
对连续77例患有严重主动脉瓣疾病的患者的向量心电图（VCG）进行了分析。所有患者均进行了完整的左右心导管检查，冠状动脉造影正常，左心室收缩功能正常。35例（46%）患者符合前壁心肌梗死（AMI - 35%）和/或下壁心肌梗死（IMI - 14%）的VCG标准。与一组200名30岁以下的正常志愿者和100名经心导管检查心脏正常的患者相比，这两个标准的假阳性诊断率显著增加（P小于0.01）。研究发现，如果当最大横面幅值大于1.9 mV时推迟VCG对心肌梗死的诊断，AMI假阳性诊断率降至3%，IMI假阳性诊断率降至1%。同样的规则应用于主动脉瓣疾病队列、一组124例记录有AMI的患者和一组158例IMI患者。这使得AMI标准的敏感性从93%降至83%，IMI标准的敏感性从85%降至77%。对于AMI标准，平均性能的提高具有统计学意义（P小于0.05），但对于IMI标准则没有。
