Akakabe Yoshiki, Kawasaki Tatsuya, Yamano Michiyo, Miki Shigeyuki, Kamitani Tadaaki, Kuribayashi Toshiro, Matsubara Hiroaki, Sugihara Hiroki
Department of Cardiology, Matsushita Memorial Hospital, 5-55 Sotojima, Moriguchi 570-8540, Japan.
Circ J. 2008 Jun;72(6):953-7. doi: 10.1253/circj.72.953.
Small Q waves in the left lateral leads are termed septal q waves, and their response to exercise has been reported to be a marker of septal ischemia in coronary artery disease. Patients with hypertrophic cardiomyopathy (HCM) sometimes develop septal ischemia in the absence of coronary stenosis, but little data are available concerning the association of the septal q wave response with septal ischemia.
Exercise electrocardiography and Tc-99m-tetrofosmin myocardial scintigraphy were recorded to detect myocardial ischemia in 29 HCM patients with asymmetric septal hypertrophy. The septal q wave amplitude was summed up in V(5) and V(6) during exercise testing, and the results were correlated with septal ischemia defined as a regional septal ischemia or a part of diffuse subendocardial ischemia. A decrease in the sum of the septal q wave amplitude during exercise testing yielded a sensitivity of 100% and specificity 33% for regional septal ischemia, and a sensitivity of 100% and specificity of 43% for diffuse subendocardial ischemia, although an absent septal q wave at rest provided a low sensitivity for the detection of regional septal ischemia (43%) and diffuse subendocardial ischemia (33%).
The septal q wave response to exercise is a useful marker of septal ischemia in HCM with asymmetric septal hypertrophy.
左外侧导联出现的小Q波被称为间隔q波，据报道其对运动的反应是冠状动脉疾病中间隔缺血的一个标志物。肥厚型心肌病（HCM）患者有时在无冠状动脉狭窄的情况下会发生间隔缺血，但关于间隔q波反应与间隔缺血之间关联的数据很少。
对29例伴有不对称间隔肥厚的HCM患者进行运动心电图和锝-99m-替曲膦心肌闪烁扫描以检测心肌缺血。在运动试验期间，将V(5)和V(6)导联的间隔q波振幅相加，其结果与定义为局部间隔缺血或弥漫性心内膜下缺血一部分的间隔缺血相关。运动试验期间间隔q波振幅总和降低，对局部间隔缺血的敏感性为100%，特异性为33%；对弥漫性心内膜下缺血的敏感性为100%，特异性为43%，尽管静息时无间隔q波对检测局部间隔缺血（43%）和弥漫性心内膜下缺血（33%）的敏感性较低。
运动时的间隔q波反应是伴有不对称间隔肥厚的HCM中间隔缺血的一个有用标志物。
