Saetre H A, Selvester R H, Solomon J C, Baron K A, Ahmad J, Ellestad M E
Memorial Heart Institute of Long Beach, California.
J Electrocardiol. 1992;24 Suppl:153-62.
Percutaneous transluminal coronary angioplasty (PTCA) occlusion in five individual coronary artery distributions produced significant ST elevation ("current of injury") in 48/50 PTCAs in 46 patients. Four patients had PTCA of two separate coronary arteries. Two patients had no significant ischemic ST changes in the 16 simultaneous lead ECG and no chest pain with PTCA. The six limb leads were recorded from Mason-Likar locations modified by moving them centrally on the anterior torso; the V leads were recorded in standard locations, except V1 was moved to V3R. Four extra leads were placed as follows: (1) left axilla, (2) left subcostal margin, (3) V8, and (4) midback at the level of V4-V8. The left axillary and back leads discriminated diagonal and left circumflex (LCX) PTCAs from the others and from each other. V6 showed ST elevation in all LCX PTCAs and in only 10% of left anterior descending occlusions. V3R showed ST elevation in 82% of right coronary PTCAs. In 48/50 (96%) of PTCA occlusions the ST elevation was localized to the torso locations defined in Forward Model Simulations as specific for the arterial perfusion bed involved. These data strongly support the hypothesis that additional resolution and sensitivity to ischemic change is to be expected with a broader array of ECG leads.
在46例患者的50次经皮腔内冠状动脉成形术（PTCA）中，5种不同冠状动脉分布区域的PTCA闭塞在48次操作中产生了显著的ST段抬高（“损伤电流”）。4例患者接受了两条不同冠状动脉的PTCA。2例患者在同步记录的16导联心电图中无明显缺血性ST段改变，且PTCA过程中无胸痛。6个肢体导联从Mason-Likar位置记录，通过将其移至躯干前部中央进行修改；V导联在标准位置记录，但V1移至V3R。另外放置了4个导联，如下所示：（1）左腋窝，（2）左肋下缘，（3）V8，（4）V4 - V8水平的背部中间位置。左腋窝导联和背部导联能够将对角支和左旋支（LCX）的PTCA与其他情况区分开来，也能区分彼此。V6在所有LCX的PTCA中均显示ST段抬高，而在仅10%的左前降支闭塞中出现ST段抬高。V3R在82%的右冠状动脉PTCA中显示ST段抬高。在50次PTCA闭塞中的48次（96%）中，ST段抬高局限于正向模型模拟中定义的、与所涉及的动脉灌注床特定相关的躯干位置。这些数据有力地支持了这样一种假设，即使用更广泛的心电图导联阵列有望获得更高的缺血变化分辨率和敏感性。
