Reddy Chatla V R, Cheriparambill Kuruvilla, Saul Barry, Makan Majesh, Kassotis John, Kumar Awaneesh, Das Mithilesh Kumar
New York Methodist Hospital, New York , USA.
Ann Noninvasive Electrocardiol. 2006 Apr;11(2):132-8. doi: 10.1111/j.1542-474X.2006.00094.x.
A left ventricular aneurysm (LVA) occurs between 3.5% and 9.4% of all cases of acute myocardial infarction. A fragmented left sided QRS (RSR; pattern or its variant RSr;, rSR;, or rSr;) without evidence of bundle branch block (QRS duration <or=120 ms) on the ECG may be associated with a significant myocardial scar, which is the characteristic of a LVA. We, therefore, postulate that fragmented QRS (RSR; pattern or its variant) in the left sided leads (I, aVL, V(3) to V(6)) may be a useful sign of LVA.
ECGs of 110 consecutive patients with LVA documented by left ventricular angiography (30 degrees right anterior oblique view) was compared with 220 patients without LVA (110 patients with and 110 patients without coronary artery disease (CAD)), who were evaluated for CAD by symptoms and signs.
The sensitivity of the fragmented QRS for identification of LVA was 50% (55 of 110 patients) and specificity was 94.6% (209 of 220). Within the study population, the positive predictive value of the fragmented QRS for LVA was 83.3% (55 of 66) and the negative predictive value was 79.2% (209 of 264). Based on the range of prevalence of LVA in postmyocardial infarction population (3.5-9.4%) and on observed sensitivity and specificity, the positive predictive value of fragmented QRS for LVA after infarction can be estimated at 29-53% and the negative predictive value can be estimated at 95-98%.
The sensitivity of fragmented QRS in left precordial leads for LVA was only 50%, whereas the specificity was 94.5%. It has a relatively low to moderate positive predictive value and high negative predictive value.
左心室室壁瘤（LVA）在所有急性心肌梗死病例中的发生率为3.5%至9.4%。心电图上出现左侧QRS波群碎裂（RSR′型或其变异型RSr′、rSR′或rSr′）且无束支传导阻滞证据（QRS波时限≤120毫秒），可能与显著心肌瘢痕有关，而这是左心室室壁瘤的特征。因此，我们推测左侧导联（I、aVL、V3至V6）出现QRS波群碎裂（RSR′型或其变异型）可能是左心室室壁瘤的一个有用征象。
将连续110例经左心室血管造影（右前斜30度位）证实有左心室室壁瘤患者的心电图与220例无左心室室壁瘤患者（110例有冠状动脉疾病（CAD）和110例无冠状动脉疾病）的心电图进行比较，后者通过症状和体征评估是否患有CAD。
QRS波群碎裂对左心室室壁瘤的识别敏感度为50%（110例患者中的55例），特异度为94.6%（220例中的209例）。在研究人群中，QRS波群碎裂对左心室室壁瘤的阳性预测值为83.3%（66例中的55例），阴性预测值为79.2%（264例中的209例）。根据心肌梗死后人群中左心室室壁瘤的患病率范围（3.5% - 9.4%）以及观察到的敏感度和特异度，心肌梗死后QRS波群碎裂对左心室室壁瘤的阳性预测值估计为29% - 53%，阴性预测值估计为95% - 98%。
胸前导联QRS波群碎裂对左心室室壁瘤的敏感度仅为50%，而特异度为94.5%。其阳性预测值相对较低至中等，阴性预测值较高。
