Goldwasser Diego, Senthilkumar Annamalai, Bayés de Luna Antonio, Elosua Roberto, Carreras Francesc, Pons-Llado Guillem, Kim Raymond J
Cardiovascular Research Center, CSIC-ICCC, Barcelona, Spain.
Duke Cardiovascular Magnetic Resonance Center, Durham, NC, USA.
Ann Noninvasive Electrocardiol. 2015 Nov;20(6):570-7. doi: 10.1111/anec.12260. Epub 2015 Mar 12.
It is necessary to clarify if the presence of a prominent R wave in V1, in post-myocardial infarction (MI) patients, is due to the involvement of the posterior wall (currently inferobasal segment) or the lateral wall (as has been demonstrated recently by electrocardiographic contrast-enhanced cardiac magnetic resonance [ECG-CE-CMR] correlations studies).
In 155 patients with inferolateral zone MI, as detected by CE-CMR, the following ECG parameters were evaluated and correlated with MI location according to CE-CMR: R/S ratio in V1 ≥ 1 (classic criteria for posterior MI), R/S ratio in V1 ≥ 0.5, and R in V1 ≥ 3 mm.
R/S ≥ 1 criterion: Present in 20 cases: 3 of lateral MI, 17 of inferolateral MI, 0 of inferior MI. Absent in 135 cases, 81 of lateral/inferolateral MI (28/53), 54 of inferior MI (SE 19.8%, SP 100%). R/S ≥ 0.5 criterion: Present in 47 cases: 6 of lateral MI, 39 of inferolateral MI, 2 of inferior MI. Absent in 108 cases, 56 of lateral/inferolateral MI (25/31), 52 of inferior MI (SE 44.6%, SP 96.4%). R ≥ 3 mm criterion: Present in 30 cases: 5 of IM lateral, 23 of inferolateral MI, 2 of inferior MI. Absent in 125 cases, 73 lateral/inferolateral MI (26/47), 52 inferior MI (SE 27.7%, SP 96.4%).
The presence of prominent the R wave in V1 is due to the lateral MI and not to the involvement of inferobasal segment of inferior wall (old posterior wall).
有必要明确心肌梗死后（MI）患者V1导联出现显著R波是由于后壁（目前的下基底段）受累还是侧壁受累（正如最近心电图对比增强心脏磁共振[ECG-CE-CMR]相关性研究所证实的那样）。
在155例经CE-CMR检测为下外侧区心肌梗死的患者中，评估以下心电图参数，并根据CE-CMR将其与心肌梗死部位进行相关性分析：V1导联R/S比值≥1（后壁心肌梗死的经典标准）、V1导联R/S比值≥0.5以及V1导联R波≥3mm。
R/S≥1标准：20例存在：侧壁心肌梗死3例，下外侧心肌梗死17例，下壁心肌梗死0例。135例不存在，其中侧壁/下外侧心肌梗死81例（28/53），下壁心肌梗死54例（灵敏度19.8%，特异度100%）。R/S≥0.5标准：47例存在：侧壁心肌梗死6例，下外侧心肌梗死39例，下壁心肌梗死2例。108例不存在，其中侧壁/下外侧心肌梗死56例（25/31），下壁心肌梗死52例（灵敏度44.6%，特异度96.4%）。R≥3mm标准：30例存在：下外侧壁心肌梗死5例，下外侧心肌梗死23例，下壁心肌梗死2例。125例不存在，其中侧壁/下外侧心肌梗死73例（26/47），下壁心肌梗死52例（灵敏度27.7%，特异度96.4%）。
V1导联出现显著R波是由于侧壁心肌梗死，而非下壁（旧后壁）下基底段受累。
