Maynard S J, Menown I B A, Manoharan G, Allen J, McC Anderson J, Adgey A A J
Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
Heart. 2003 Sep;89(9):998-1002. doi: 10.1136/heart.89.9.998.
To test prospectively depolarisation and repolarisation body surface maps (BSMs) for mirror image reversal, which is less susceptible to artefact, in patients with acute ischaemic-type chest pain, and to compare these BSM criteria with previously published 12 lead ECG criteria.
An 80 lead portable BSM system was used to map patients presenting with acute ischaemic-type chest pain and a 12 lead ECG with left bundle branch block (LBBB). Acute myocardial infarction (AMI) was defined by serial cardiac enzymes. Each 12 lead ECG was assessed by the criteria of Sgarbossa et al and Hands et al for diagnosis of AMI. Depolarisation and repolarisation BSMs were assessed for loss of mirror image reversal of QRS with ST-T isointegral map patterns and a change in vector angle from QRS to ST-T outside 180+/-15 degrees -findings typically seen in LBBB with AMI.
Of 56 patients with chest pain and LBBB, 18 had enzymatically confirmed AMI. Patients with loss of BSM image reversal were significantly more likely to have AMI (odds ratio 4.9, 95% confidence interval 1.5 to 16.4, p = 0.007). Loss of BSM image reversal was significantly more sensitive (67%) for AMI than either 12 lead ECG method (17%, 33%) albeit with some loss in specificity (BSM 71%, 12 lead ECG 87%, 97%). Patients with AMI compared with those without AMI had a greater mean change in vector angle outside the normal range (180+/-15 degrees ), particularly between QRS isointegral and ST60 isopotential (the potential 60 ms after the J point at each electrode site) BSMs (19 degrees v 9 degrees, p = 0.038). Loss of image reversal and QRS-ST60 vector change outside 180+/-15 degrees had 61% sensitivity and 82% specificity for AMI (odds ratio 7.0, 95% confidence interval 2.0 to 24.4, p = 0.001).
BSM compared with the 12 lead ECG improved the early diagnosis of AMI in the presence of LBBB.
前瞻性地测试急性缺血性胸痛患者的去极化和复极化体表电位图（BSM）是否存在镜像反转，镜像反转受伪影影响较小，并将这些BSM标准与先前发表的12导联心电图标准进行比较。
使用80导联便携式BSM系统对急性缺血性胸痛患者及伴有左束支传导阻滞（LBBB）的12导联心电图进行绘图。急性心肌梗死（AMI）通过系列心肌酶进行定义。每一份12导联心电图均按照Sgarbossa等人及Hands等人的标准进行评估以诊断AMI。通过QRS波镜像反转的丧失、ST-T等积分图模式以及QRS波至ST-T向量角度在180°±15°范围外的变化来评估去极化和复极化BSM，这些表现通常见于合并AMI的LBBB患者。
在56例胸痛伴LBBB患者中，18例经酶学证实为AMI。BSM镜像反转丧失的患者发生AMI的可能性显著更高（比值比4.9，95%置信区间1.5至16.4，p = 0.007）。BSM镜像反转丧失对AMI的敏感性显著更高（67%），高于两种12导联心电图方法（分别为17%、33%），尽管特异性有所降低（BSM为71%，12导联心电图分别为87%、97%）。与未发生AMI的患者相比，发生AMI的患者向量角度在正常范围（180°±15°）外的平均变化更大，尤其是在QRS等积分图和ST60等电位图（每个电极部位J点后60毫秒的电位）之间的BSM（19°对9°，p = 0.038）。镜像反转丧失及QRS-ST60向量在180°±15°范围外的变化对AMI的敏感性为61%，特异性为82%（比值比7.0，95%置信区间2.0至24.4，p = 0.001）。
与12导联心电图相比，BSM改善了LBBB患者中AMI的早期诊断。
