Klein Lauren R, Shroff Gautam R, Beeman William, Smith Stephen W
Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Ave, Minneapolis, MN, USA.
Division of Cardiology, Department of Medicine, Hennepin County Medical Center, 701 Park Ave, Minneapolis, MN, USA.
Am J Emerg Med. 2015 Jun;33(6):786-90. doi: 10.1016/j.ajem.2015.03.044. Epub 2015 Mar 27.
ST elevation (STE) on the electrocardiogram (ECG) may be due to acute myocardial infarction (AMI) or other nonischemic pathologies such as left ventricular aneurysm (LVA). The objective of this study was to validate 2 previously derived ECG rules to distinguish AMI from LVA. The first rule states that if the sum of T-wave amplitudes in leads V1 to V4 divided by the sum of QRS amplitudes in leads V1 to V4 is greater than 0.22, then acute ST-segment elevation MI is predicted. The second rule states that if any 1 lead (V1-V4) has a T-wave amplitude to QRS amplitude ratio greater than or equal to 0.36, then acute ST-segment elevation MI is predicted.
This was a retrospective analysis of patients with AMI (n = 59) and LVA (n = 16) who presented with ischemic symptoms and STE on the ECG. For each ECG, the T-wave amplitude and QRS amplitude in leads V1 to V4 were measured. These measurements were applied to the 2 ECG rules; and sensitivity, specificity, and accuracy in predicting AMI vs LVA were calculated.
For rule 1 (sum of ratios in V1-V4), sensitivity was 91.5%, specificity was 68.8%, and accuracy was 86.7% in predicting AMI. For rule 2 (maximum ratio in V1-V4), sensitivity was 91.5%, specificity was 81.3%, and accuracy was 89.3% in predicting AMI.
When patients present to the emergency department with ischemic symptoms and the differential diagnosis for STE on the ECG is AMI vs LVA, these 2 ECG rules may be helpful in differentiating these 2 pathologies. Both rules are highly sensitive and accurate in predicting AMI vs LVA.
心电图（ECG）上的ST段抬高（STE）可能由急性心肌梗死（AMI）或其他非缺血性病变引起，如左心室室壁瘤（LVA）。本研究的目的是验证两条先前推导的用于区分AMI和LVA的心电图规则。第一条规则指出，如果V1至V4导联T波振幅总和除以V1至V4导联QRS振幅总和大于0.22，则预测为急性ST段抬高型心肌梗死。第二条规则指出，如果任何一个导联（V1 - V4）的T波振幅与QRS振幅之比大于或等于0.36，则预测为急性ST段抬高型心肌梗死。
这是一项对出现缺血症状且心电图有STE的急性心肌梗死患者（n = 59）和左心室室壁瘤患者（n = 16）的回顾性分析。对于每份心电图，测量V1至V4导联的T波振幅和QRS振幅。将这些测量值应用于两条心电图规则；并计算预测AMI与LVA的敏感性、特异性和准确性。
对于规则1（V1 - V4导联比值总和），预测AMI时敏感性为91.5%，特异性为68.8%，准确性为86.7%。对于规则2（V1 - V4导联最大比值），预测AMI时敏感性为91.5%，特异性为81.3%，准确性为89.3%。
当患者因缺血症状就诊于急诊科且心电图STE的鉴别诊断为AMI与LVA时，这两条心电图规则可能有助于区分这两种病变。两条规则在预测AMI与LVA方面均具有高度敏感性和准确性。
