Kühl Jørgen Tobias, Berg Ronan M G
Department of Cardiology, The Heart Centre, University Hospital Rigshospitalet, Copenhagen, Denmark.
Ann Noninvasive Electrocardiol. 2009 Jul;14(3):219-25. doi: 10.1111/j.1542-474X.2009.00300.x.
Lead aVR is a neglected, however, potentially useful tool in electrocardiography. Our aim was to evaluate its value in clinical practice, by reviewing existing literature regarding its utility for identifying the culprit lesion in acute myocardial infarction (AMI).
Based on a systematic search strategy, 16 studies were assessed with the intent to pool data; diagnostic test rates were calculated as key results.
Five studies investigated if ST-segment elevation (STE) in aVR is valuable for the diagnosis of left main stem stenosis (LMS) in non-ST-segment AMI (NSTEMI). The studies were too heterogeneous to pool, but the individual studies all showed that STE in aVR has a high negative predictive value (NPV) for LMS. Six studies evaluated if STE in aVR is valuable for distinguishing proximal from distal lesions in the left anterior descending artery (LAD) in anterior ST-segment elevation AMI (STEMI). Pooled data showed a sensitivity of 47%, a specificity of 96%, a positive predicative value (PPV) of 91% and a NPV of 69%. Five studies examined if ST-segment depression (STD) in lead aVR is valuable for discerning lesions in the circumflex artery from those in the right coronary artery in inferior STEMI. Pooled data showed a sensitivity of 37%, a specificity of 86%, a PPV of 42%, and an NPV of 83%.
The absence of aVR STE appears to exclude LMS as the underlying cause in NSTEMI; in the context of anterior STEMI, its presence indicates a culprit lesion in the proximal segment of LAD.
然而，aVR导联在心电图中是一个被忽视但可能有用的工具。我们的目的是通过回顾现有关于其在急性心肌梗死（AMI）中识别罪犯病变的文献，评估其在临床实践中的价值。
基于系统的检索策略，评估了16项研究以汇总数据；计算诊断测试率作为关键结果。
五项研究调查了aVR导联ST段抬高（STE）对非ST段抬高型心肌梗死（NSTEMI）中左主干狭窄（LMS）诊断的价值。这些研究异质性太大无法汇总，但各项研究均表明aVR导联STE对LMS具有较高的阴性预测值（NPV）。六项研究评估了aVR导联STE对前壁ST段抬高型心肌梗死（STEMI）中左前降支（LAD）近端与远端病变鉴别的价值。汇总数据显示敏感性为47%，特异性为96%，阳性预测值（PPV）为91%，NPV为69%。五项研究检查了aVR导联ST段压低（STD）对下壁STEMI中回旋支病变与右冠状动脉病变鉴别的价值。汇总数据显示敏感性为37%，特异性为86%，PPV为42%，NPV为83%。
aVR导联STE缺失似乎可排除LMS作为NSTEMI的潜在病因；在前壁STEMI情况下，其存在提示LAD近端的罪犯病变。
