Yang Hyun Suk, Lee Cheol Whan, Hong Myeong-Ki, Moon Dae-Hyuk, Kim Young-Hak, Lee Sang-Gon, Han Ki-Hoon, Kim Jae-Joong, Park Seong-Wook, Park Seung-Jung
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Korean J Intern Med. 2005 Mar;20(1):21-5. doi: 10.3904/kjim.2005.20.1.21.
Terminal QRS complex distortion on admission is a simple and reliable predictor of infarct size in patients with acute myocardial infarction (AMI). It is uncertain, however, whether this reflects reduced myocardial perfusion of the infarct area and a larger area of the myocardium at risk. This study was conducted to investigate whether terminal QRS distortion complex on admission is a reliable predictor of reduced residual flow and a larger area of the myocardium at risk compared to patients who are admitted without a terminal QRS distortion.
We evaluated the relationship between terminal QRS complex distortion and residual flow to the infarct zone and risk area in 46 anterior AMI patients undergoing primary angioplasty. (99m)Tc-sestamibi imaging was performed at baseline and 5-9 days after angioplasty. The study population was divided into those with (Group I, n=16) and without (Group II, n=30) terminal QRS complex distortion.
Baseline characteristics were similar between the two groups. The area of the myocardium at risk was higher in Group I (59.9 +/- 15.3%) than in Group 11 (48.6 +/- 13.7%, p < 0.05; mean+SD) while the nadir measurement of the residual flow was lower in Group I (0.10 +/- 0.07) than in Group 11 (0.16 +/- 0.09, p < 0.05). Although the final infarct size was significantly higher in Group I (40.8 +/- 17.2%) than in Group 11 (27.1 +/- 18.1%, p < 0.05), the myocardial salvage index did not differ significantly between the two groups.
Terminal QRS complex distortion seems to be associated with less residual flow to the infarct zone, a larger risk area and greater infarct size in patients with anterior AMI.
急性心肌梗死（AMI）患者入院时终末QRS波群变形是梗死面积的一个简单且可靠的预测指标。然而，这是否反映梗死区域心肌灌注减少以及更大面积的心肌处于危险状态尚不确定。本研究旨在探讨与无终末QRS波群变形的入院患者相比，入院时终末QRS波群变形是否是梗死区域残余血流减少和更大面积心肌处于危险状态的可靠预测指标。
我们评估了46例接受直接血管成形术的前壁AMI患者终末QRS波群变形与梗死区域残余血流及危险区域之间的关系。在基线及血管成形术后5 - 9天进行（99m）锝 - 甲氧基异丁基异腈显像。研究人群分为有终末QRS波群变形（I组，n = 16）和无终末QRS波群变形（II组，n = 30）两组。
两组的基线特征相似。I组心肌危险面积（59.9±15.3%）高于II组（48.6±13.7%，p < 0.05；均值±标准差），而I组残余血流最低点测量值（0.10±0.07）低于II组（0.16±0.09，p < 0.05）。虽然I组最终梗死面积（40.8±17.2%）显著高于II组（27.1±18.1%，p < 0.05），但两组心肌挽救指数差异无统计学意义。
前壁AMI患者终末QRS波群变形似乎与梗死区域残余血流减少、更大的危险区域和更大的梗死面积相关。
