Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, University of Leeds, , Leeds, United Kingdom.
Heart. 2013 Nov;99(22):1658-62. doi: 10.1136/heartjnl-2013-304439. Epub 2013 Sep 7.
ST-elevation acute myocardial infarction (STEMI) is frequently associated with reciprocal ST depression in contralateral ECG leads. The relevance of these changes is debated. This study examined whether reciprocal ECG changes in STEMI reflect larger myocardial area at risk (AAR) and/or infarct size.
Patients were stratified by presence of reciprocal change on the presenting ECG, defined as ≥ 1 mm ST depression in ≥ 2 inferior leads for anterior STEMI, or ≥ 2 anterior leads for inferior STEMI. Infarcted tissue was defined on late enhancement and AAR on T2-weighted cardiovascular magnetic resonance (CMR).
Patients with reperfused first STEMI underwent CMR within 3 days of presentation.
In addition to AAR and infarct mass, myocardial salvage was calculated as (AAR mass-infarct mass) and salvage index as myocardial salvage/AAR mass.
Thirty-five patients were analysed (n=35). Patients with reciprocal ECG changes (n=19) had higher AAR mass than those without (42 g vs 29 g, p<0.001), and higher myocardial salvage (27 g vs 9 g, p<0.001) and myocardial salvage index (61% vs 17%, p<0.001) but similar infarct size (16 g vs 20 g, p=0.3) and ejection fraction (43% vs 45%, p=0.5).
STEMI patients with reciprocal ECG changes have larger AAR, higher myocardial salvage and salvage index than those without. Reciprocal changes appear to be a marker of increased ischaemic myocardium at risk and indicate the potential for increased salvage with emergency revascularisation. Reciprocal changes showed no relationship to infarct size, which may be influenced by ischaemia time and other treatment factors.
ST 段抬高型急性心肌梗死（STEMI）常伴有对侧心电图导联的对应性 ST 段压低。这些变化的相关性存在争议。本研究旨在探讨 STEMI 患者心电图对应性改变是否反映更大的心肌危险区（AAR）和/或梗死面积。
根据患者就诊心电图上是否存在对应性改变进行分层，定义为前壁 STEMI 患者下壁导联中至少 1 个导联 ST 段压低≥1mm，或下壁 STEMI 患者前壁导联中至少 2 个导联 ST 段压低≥1mm。通过晚期钆增强扫描确定梗死组织，通过 T2 加权心血管磁共振（CMR）确定 AAR。
接受再灌注治疗的首发 STEMI 患者在发病后 3 天内行 CMR 检查。
除 AAR 和梗死面积外，还计算心肌挽救（用 AAR 质量减去梗死质量表示）和挽救指数（心肌挽救/AAR 质量）。
共分析了 35 例患者（n=35）。与无对应性心电图改变的患者（n=16）相比，存在对应性心电图改变的患者（n=19）具有更大的 AAR 质量（42g 比 29g，p＜0.001）、更高的心肌挽救（27g 比 9g，p＜0.001）和心肌挽救指数（61%比 17%，p＜0.001），但梗死面积（16g 比 20g，p=0.3）和射血分数（43%比 45%，p=0.5）无显著差异。
与无对应性心电图改变的 STEMI 患者相比，存在对应性心电图改变的患者具有更大的 AAR、更高的心肌挽救和挽救指数。对应性改变似乎是危险的缺血性心肌增加的标志物，并表明紧急血运重建可能会增加挽救。对应性改变与梗死面积无相关性，这可能受到缺血时间和其他治疗因素的影响。
