Nishian K, Nomoto Y, Naruse H, Kawakami K, Asakuma S, Tateishi J, Yasutomi N, Fujitani K, Iwasaki T
First Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya.
J Cardiol. 1989 Jun;19(2):413-24.
To determine whether precordial ST segment depression during acute inferior myocardial infarction indicates posterolateral wall ischemia, anatomical predominance of coronary circulation was examined by coronary angiography and evaluated in 43 patients who experienced first acute inferior myocardial infarction. Among patients who underwent intracoronary thrombolysis within six hours from the onset of symptoms, the infarct-related artery was the right coronary artery (RCA) in 35. In addition, their early 12-lead electrocardiographic features were compared with those in eight patients having the infarct-related left circumflex coronary artery (group Cx). Thirty-five patients with RCA obstruction were categorized in four groups: Four patients with left predominant type (group L), 10 with balanced type (group B), five with right super-predominant type (group SR), and 16 with right intermediate type (group RI). Seventeen of the 21 patients in groups SR and RI demonstrated precordial ST segment depression, whereas it was present in only six of the 14 patients in groups L and B (p less than 0.05). Of the 29 patients in groups SR, Cx and RI, total ST segment depression in leads V1 through V4 (sigma ST) was greater in the 14 patients in groups L and B (p less than 0.05) than in other groups. Furthermore, in these 29, all patients in groups SR and Cx had greater sigma ST than did the patients in group RI (p less than 0.05). There was no significant difference in sigma ST between groups SR and Cx. Precordial ST segment depression did not correlate with concomitant disease of the left anterior descending artery and was not a mirror image of ST segment elevation in inferior leads. On thallium-201 scintigraphy, additional perfusion defects of the posterolateral wall were present in all eight patients in group Cx and in ten of the 21 patients in groups SR and RI. Thus, precordial ST segment depression during acute inferior myocardial infarction seemed to be affected by the pattern of coronary circulation. It was concluded that this ST depression represents more extensive involvement of the posterolateral wall in patients with right predominant coronary circulation as well as in those with left circumflex artery obstruction.
为了确定急性下壁心肌梗死时胸前导联ST段压低是否提示后侧壁缺血，通过冠状动脉造影检查了43例首次发生急性下壁心肌梗死患者的冠状动脉循环解剖优势并进行评估。在症状发作后6小时内接受冠状动脉内溶栓的患者中，35例梗死相关动脉为右冠状动脉（RCA）。此外，将他们的早期12导联心电图特征与8例梗死相关动脉为左旋支冠状动脉的患者（Cx组）进行比较。35例RCA阻塞患者分为四组：4例左优势型（L组），10例均衡型（B组），5例右超优势型（SR组），16例右中间型（RI组）。SR组和RI组的21例患者中有17例出现胸前导联ST段压低，而L组和B组的14例患者中只有6例出现（p<0.05）。在SR组、Cx组和RI组的29例患者中，L组和B组的14例患者V1至V4导联的总ST段压低（σST）大于其他组（p<0.05）。此外，在这29例患者中，SR组和Cx组的所有患者的σST均大于RI组患者（p<0.05）。SR组和Cx组之间的σST无显著差异。胸前导联ST段压低与左前降支动脉合并疾病无关，也不是下壁导联ST段抬高的镜像。在铊-201心肌显像中，Cx组的所有8例患者以及SR组和RI组的21例患者中的10例出现后侧壁额外的灌注缺损。因此，急性下壁心肌梗死时胸前导联ST段压低似乎受冠状动脉循环模式的影响。得出的结论是，这种ST段压低代表右优势冠状动脉循环患者以及左旋支动脉阻塞患者后侧壁更广泛的受累。
