血管造影证实的优势型左旋支动脉闭塞伴急性下壁心肌梗死的心电图特征：ST段抬高Ⅲ/Ⅱ比值及外侧肢体导联ST段偏移的局限性

Electrocardiographic characteristics in angiographically documented occlusion of the dominant left circumflex artery with acute inferior myocardial infarction: limitations of ST elevation III/II ratio and ST deviation in lateral limb leads.

作者信息

Zhan Zhong-qun, Wang Wei, Dang Shu-yi, Wang Chong-quan, Wang Jun-feng, Cao Zheng

机构信息

Department of Cardiology, Shiyan TaiHe Hospital, Yunyang Medical College, Shiyan, Hubei Province, China.

出版信息

J Electrocardiol. 2009 Sep-Oct;42(5):432-9. doi: 10.1016/j.jelectrocard.2009.03.015. Epub 2009 May 15.

DOI:10.1016/j.jelectrocard.2009.03.015

PMID:19446838

Abstract

BACKGROUND

The prognosis of dominant left circumflex artery (LCx) occlusion-related inferior acute myocardial infarction (AMI) patients is poor, but the electrocardiographic (ECG) characteristics of this AMI entity have not been described.

METHODS

One hundred thirty-five patients with first dominant right coronary artery (RCA) or dominant LCx-related inferior AMI were included. The characteristics of ECG obtained on admission for 55 patients with culprit lesions proximal to the first major right ventricular (RV) branch of dominant RCA (group proximal dominant RCA), 62 patients with culprit lesions distal to the first major RV branch of dominant RCA (group distal dominant RCA), and 18 patients with culprit lesions in dominant LCx (group dominant LCx) were compared.

RESULTS

There were no significant differences among the 3 groups in the prevalence regarding an S/R ratio greater than 1:3 in aVL, ST elevation in aVR (ST upward arrow(aVR)), ST depression in aVR (ST downward arrow(aVR)) of 1 mm or more, and atrioventricular block. Greater ST elevation in lead III than in II and greater ST depression in aVL than I showed specificity of 17% and 44% to identify dominant RCA as culprit lesion, respectively. All 3 groups could be distinguished on the basis of ST upward arrow(V4R), ST downward arrow(V4R), ST downward arrow(V3)/ST upward arrow(III) of 1.2 or less, and ST downward arrow(V3)/ST upward arrow(III) of more than 1.2.

CONCLUSIONS

Greater ST elevation in lead III than in II, greater ST depression in aVL than I, and an S/R ratio of greater than 1:3 in aVL were not useful to discriminate between dominant RCA and dominant LCx occlusion-related inferior AMI. ST-segment deviation in lead V(4)R and the ratio of ST downward arrow(V3)/ST upward arrow(III) were useful in predicting the dominant artery occlusion-related inferior AMI.

摘要

背景

优势型左旋支动脉（LCx）闭塞相关的下壁急性心肌梗死（AMI）患者预后较差，但尚未描述该类型AMI的心电图（ECG）特征。

方法

纳入135例首次发生的优势型右冠状动脉（RCA）或优势型LCx相关下壁AMI患者。比较了55例罪犯病变位于优势型RCA第一大右心室（RV）分支近端的患者（近端优势型RCA组）、62例罪犯病变位于优势型RCA第一大RV分支远端的患者（远端优势型RCA组）和18例优势型LCx罪犯病变患者（优势型LCx组）入院时的ECG特征。

结果

三组在aVL导联S/R比值大于1:3、aVR导联ST段抬高（ST↑(aVR)）、aVR导联ST段压低（ST↓(aVR)）≥1mm以及房室传导阻滞的发生率方面无显著差异。III导联ST段抬高大于II导联以及aVL导联ST段压低大于I导联分别对识别优势型RCA为罪犯病变具有17%和44%的特异性。根据ST↑(V4R)、ST↓(V4R)、ST↓(V3)/ST↑(III)≤1.2以及ST↓(V3)/ST↑(III)>1.2可区分所有三组。