Nough H, Jorat M V, Varasteravan H R, Ahmadieh M H, Tavakkolian N, Sheikhvatan M
Yazd University of Medical Sciences, Afshar Hospital, Yazd, Iran.
Rom J Intern Med. 2012 Apr-Jun;50(2):159-64.
The use of lead aVR for predicting appearance of left main coronary artery (LMCA) lesion has been recently a subject of great interest. This study evaluates the predictive value of ST-segment elevation in lead aVR on electrocardiogram in the diagnosis of significant LMCA lesions.
The study population consisted of 400 consecutive patients admitted within 6 hours from the onset of typical chest pain to coronary care unit (CCU). Electrocardiogram was recorded after the admission to emergency ward. ST segment elevation in aVR lead was measured and coronary angiography was performed within 48 hours admission to CCU.
Overall, 31% of suspected patients had ST segment elevation in aVR lead that elevation more than 0.1 mv was observed in 34.7% of all subjects. High incidence of ST segment elevation > 0.1 mv was seen in the group with left main lesion so that 40.7% of men and 43.8% of women with (LMCA) lesion had ST segment elevation > 0.1 mv. There was a significant relationship between the incidence of ST segment elevation > 0.1 mv and the number of diseased coronary vessels in men. However, this relation was not observed in women. Different risk profile of ACS did not influence the incidence of the ST-segment elevation in aVR lead. Compared with coronary angiography, ST-segment elevation in lead aVR in ECG had a sensitivity of 62.7%, a specificity of 73.6%, a positive predictive value of 25.8%, and a negative predictive value of 93.1% in predicting LMCA disease.
ST-elevation of lead aVR is a valuable indicator for predicting LMCA lesion with acceptable accuracy and predictive value.
最近，使用aVR导联预测左主干冠状动脉（LMCA）病变的出现引起了极大关注。本研究评估心电图aVR导联ST段抬高对诊断显著LMCA病变的预测价值。
研究人群包括400例因典型胸痛发作后6小时内入院至冠心病监护病房（CCU）的连续患者。入院至急诊病房后记录心电图。测量aVR导联ST段抬高，并在入院至CCU后48小时内进行冠状动脉造影。
总体而言，31%的疑似患者aVR导联ST段抬高，在所有受试者中，34.7%观察到抬高超过0.1 mV。左主干病变组ST段抬高>0.1 mV的发生率较高，因此，患有（LMCA）病变的男性中有40.7%、女性中有43.8%的ST段抬高>0.1 mV。男性中ST段抬高>0.1 mV的发生率与病变冠状动脉血管数量之间存在显著关系。然而，在女性中未观察到这种关系。急性冠状动脉综合征的不同风险特征并未影响aVR导联ST段抬高的发生率。与冠状动脉造影相比，心电图aVR导联ST段抬高预测LMCA疾病的灵敏度为62.7%，特异度为73.6%，阳性预测值为25.8%，阴性预测值为93.1%。
aVR导联ST段抬高是预测LMCA病变的一个有价值的指标，具有可接受的准确性和预测价值。
