Hirano Tomohisa, Tsuchiya Kunihiko, Nishigaki Kazuhiko, Sou Kenji, Kubota Tomoki, Ojio Shinsuke, Kawasaki Masanori, Minatoguchi Shinya, Fujiwara Hisayoshi, Ueno Katsumi, Hosokawa Hiroaki, Morita Norihiko, Nagano Toshihiko, Suzuki Takahiko, Watanabe Sachirou
Department of Regenerative and Cardiovascular Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
Circ J. 2006 May;70(5):525-9. doi: 10.1253/circj.70.525.
To diagnose left main trunk (LMT) infarction by 12-lead standard electrocardiogram (ECG) is an important emergency technique, but the features in LMT infarctions have not been clarified.
The study enrolled 140 subjects who were divided into 4 groups according to the location of the culprit artery: 35 with LMT, 35 with left anterior descending artery (LAD), 35 with right coronary artery and 35 with left circumflex artery. Various parameters obtained from the ECGs were analyzed. Average QTc interval (0.51 +/- 0.06 s) in LMT group was markedly longer than that in the 3 other groups. Average QRS axis (-10 +/- 77 degrees) in LMT infarction showed a remarkable left deviation. ST-segment elevation in lead aVR occurred in 28 patients (80.0%) in the LMT group. The ECG features of the LMT group could be classified into 2 main groups: right bundle branch block (RBBB) with a marked left axis deviation (RBBB + LADEV type) and ST-segment elevation in leads V2-5, I and aVL without abnormal axis deviation (LAD type).
Either ST-segment elevation in lead aVR and marked prolongation of both the QRS width and QTc interval with a prominent abnormal axis deviation or ST-segment elevation in the broad anterior precordial lead with a normal QRS axis strongly suggests LMT infarction.
通过12导联标准心电图（ECG）诊断左主干（LMT）梗死是一项重要的急诊技术，但LMT梗死的特征尚未明确。
该研究纳入了140名受试者，根据罪犯血管的位置将其分为4组：35例LMT病变、35例左前降支（LAD）病变、35例右冠状动脉病变和35例左旋支病变。分析了从心电图中获得的各种参数。LMT组的平均QTc间期（0.51±0.06秒）明显长于其他3组。LMT梗死患者的平均QRS电轴（-10±77度）显著左偏。LMT组有28例患者（80.0%）出现aVR导联ST段抬高。LMT组的心电图特征可分为2个主要类型：右束支传导阻滞（RBBB）伴显著电轴左偏（RBBB+LADEV型）和V2-5、I及aVL导联ST段抬高且电轴无异常偏移（LAD型）。
aVR导联ST段抬高以及QRS宽度和QTc间期显著延长伴明显异常电轴偏移，或广泛前壁导联ST段抬高且QRS电轴正常，强烈提示LMT梗死。
