Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
J Cardiol. 2009 Dec;54(3):386-93. doi: 10.1016/j.jjcc.2009.06.006. Epub 2009 Jul 25.
ST-segment elevation of ≥1.0 mm in the right precordial chest lead V4R (ST↑V4R) has been shown to be a reliable marker of right ventricular involvement (RVI) in inferior acute myocardial infarction (IMI). However, the impact of left ventricular posterior wall involvement (PWI) on the relation between ST↑V4R and RVI is unknown.
We studied 267 patients with recanalized IMI due to the right coronary artery (RCA) occlusion within 6h after symptom onset. A 12-lead electrocardiogram, lead V4R, and leads V7-9 were recorded on admission. RVI was defined as occlusion proximal to the first major right ventricular branch of the RCA. The perfusion territory of the RCA was assessed by angiographic distribution score, and PWI was defined as a score of ≥0.7. Patients were stratified according to the presence or absence of PWI and RVI.
RVI was associated with higher peak creatine kinase and a higher rate of impaired myocardial reperfusion, defined as a myocardial blush grade of 0 or 1 after recanalization, in the presence or absence of PWI, especially the former. RVI was associated with a higher rate of ST↑V4R in the absence, but not in the presence, of PWI. ST↑V4R identified RVI with sensitivities of 34% and 96% (p<0.001), and specificities of 83% and 82% (NS) in the presence and absence of PWI, respectively.
In patients with recanalized IMI, RVI is associated with larger infarction and impaired myocardial reperfusion in the presence or absence of PWI, especially the former. However, the presence of PWI attenuates the predictive value of ST↑V4R for RVI.
胸前导联 V4R 的 ST 段抬高≥1.0mm（ST↑V4R）已被证明是下壁急性心肌梗死（下壁 IMI）中右心室受累（RVI）的可靠标志物。然而，左心室后壁受累（PWI）对 ST↑V4R 与 RVI 之间关系的影响尚不清楚。
我们研究了 267 例因右冠状动脉（RCA）闭塞导致的再通的下壁 IMI 患者，这些患者在症状发作后 6 小时内接受了治疗。入院时记录了 12 导联心电图、V4R 导联和 V7-9 导联。RVI 定义为 RCA 第一大右心室分支近端闭塞。通过血管造影分布评分评估 RCA 的灌注区域，PWI 定义为评分≥0.7。根据是否存在 PWI 和 RVI，患者被分为两组。
无论是否存在 PWI，RVI 与较高的肌酸激酶峰值和较高的心肌再灌注受损率（再通后心肌灌注分级为 0 或 1）相关，尤其是前者。无论是否存在 PWI，RVI 与 ST↑V4R 的发生率较高相关。在不存在 PWI 的情况下，ST↑V4R 可识别 RVI，其敏感性分别为 34%和 96%（p<0.001），特异性分别为 83%和 82%（无统计学差异）。
在再通的下壁 IMI 患者中，无论是否存在 PWI，RVI 均与更大的梗死面积和心肌再灌注受损相关，尤其是前者。然而，PWI 的存在会降低 ST↑V4R 对 RVI 的预测价值。
