Zhong-qun Zhan, Wei Wang, Chong-quan Wang, Shu-yi Dang, Chao-rong He, Jun-feng Wang
Department of Cardiology, Shiyan TaiHe Hospital, Yunyang Medical College, Shiyan, Hubei Province, China.
J Electrocardiol. 2008 Jul-Aug;41(4):329-34. doi: 10.1016/j.jelectrocard.2007.12.004. Epub 2008 Mar 19.
The correlation between ST-segment elevation (ST upward arrow) in lead V(3)R (ST upward arrow(V3R)), lead V(1) (ST upward arrow(V1)), and lead aVR (ST upward arrow(aVR)) during anterior wall acute myocardial infarction (AMI) and the culprit lesion site in the left anterior descending (LAD) coronary artery and the nature of the conal branch of the right coronary artery has not been thoroughly described.
One hundred forty-two patients with first anterior wall AMI were included. The 15-lead electrocardiogram with the standard 12 leads plus leads V(3)R through V(5)R showing the most pronounced ST-segment deviation before initiation of reperfusion therapy was evaluated and correlated with the exact LAD occlusion site in relation to the first septal perforator (S1) and the nature of the conal branch of the right coronary artery as determined by coronary angiography.
ST-segment elevation in lead aVR, ST upward arrow(V1) of at least 2 mm, and ST upward arrow(V3R) of at least 1 mm were more prevalent among patients with occlusions proximal to S1 than patients with occlusions distal to S1 (41.7% vs 4.9%, P < .01; 30.0% vs 7.3%, P < .01; and 91.7% vs 4.9%, P < .01, respectively). Of the 60 patients with occlusions proximal to S1, 20 patients had a small conal branch (18 patients with ST upward arrow(aVR) and 15 patients with ST upward arrow(V1) >or=2 mm), and 24 patients had a large conal branch (all patients with non-ST upward arrow(aVR) and ST upward arrow(V1) <2 mm; P < .01). The sensitivity of ST upward arrow(V1) of more than 1 mm, of at least 2 mm, ST upward arrow(V3R) of at least 1.5 mm, and ST upward arrow(aVR) for detecting a small conal branch was 65.1%, 81.8%, 84.0%, and 90%, respectively; the specificity was 68.5%, 64%, 66.7%, and 64.9%, respectively.
In patients with anterior wall AMI, ST upward arrow(V3R) of at least 1 mm combined with ST upward arrow in leads V(2) through V(4) were strongly predictive of LAD occlusion proximal to S1; furthermore, ST upward arrow(aVR) and ST upward arrow(V1) of at least 2 mm were found to be useful in identifying LAD occlusion proximal to S1. ST upward arrow(aVR), ST upward arrow(V3R) of at least 1.5 mm, and ST upward arrow(V1) of at least 2.0 mm were also associated with the presence of a small conal branch not reaching the intraventricular septum during anterior wall AMI.
前壁急性心肌梗死（AMI）期间，V(3)R导联（ST↑(V3R)）、V(1)导联（ST↑(V1)）和aVR导联（ST↑(aVR)）的ST段抬高与左前降支（LAD）冠状动脉罪犯病变部位及右冠状动脉圆锥支的性质之间的相关性尚未得到充分描述。
纳入142例首次发生前壁AMI的患者。评估在再灌注治疗开始前显示最明显ST段偏移的包含标准12导联加V(3)R至V(5)R导联的15导联心电图，并将其与LAD相对于第一间隔支穿支（S1）的确切闭塞部位以及通过冠状动脉造影确定的右冠状动脉圆锥支的性质进行关联。
S1近端闭塞的患者中，aVR导联ST段抬高、ST↑(V1)至少2 mm以及ST↑(V3R)至少1 mm比S1远端闭塞的患者更常见（分别为41.7%对4.9%，P <.01；30.0%对7.3%，P <.01；91.7%对4.9%，P <.01）。在60例S1近端闭塞的患者中，20例有小圆锥支（18例ST↑(aVR)，15例ST↑(V1)≥2 mm），24例有大圆锥支（所有患者无ST↑(aVR)且ST↑(V1)<2 mm；P <.01）。ST↑(V1)大于1 mm、至少2 mm、ST↑(V3R)至少1.5 mm以及ST↑(aVR)检测小圆锥支的敏感性分别为65.1%、81.8%、84.0%和90%；特异性分别为68.5%、64%、66.7%和64.9%。
在前壁AMI患者中，ST↑(V3R)至少1 mm联合V(2)至V(4)导联的ST↑强烈预测S1近端的LAD闭塞；此外，发现ST↑(aVR)和ST↑(V1)至少2 mm有助于识别S1近端的LAD闭塞。ST↑(aVR)、ST↑(V3R)至少1.5 mm以及ST↑(V1)至少2.0 mm也与前壁AMI期间未到达室间隔的小圆锥支的存在有关。
