Ikeda K, Yamaki M, Matsui M, Hanashima K, Nakamura K, Tonooka I, Meguro M, Tsuiki K, Yasui S
First Department of Internal Medicine, Yamagata University School of Medicine, Japan.
Jpn Circ J. 1989 Jul;53(7):695-706. doi: 10.1253/jcj.53.695.
Eighty-seven unipolar electrocardiograms were simultaneously recorded before and after symptom-limited treadmill exercise in 75 patients with coronary artery narrowing (greater than equal to 70%) and without previous myocardial infarction. Body surface distributions of ST segment depression were divided into 3 types; upper, lower, and diffuse types. Body surface distributions of U-wave inversion were divided into 2 types; upper, and lower types. These distribution patterns were compared with the location of ischemia determined by T1-201 exercise myocardial perfusion imaging. For ST-segment depression, a considerable number of patients had diffuse-type ST depression, whether the site of ischemia was anterior (22/32, 69%), inferior (18/27, 67%) or both (5/5, 100%). However, upper-type ST depression was associated with anterior ischemia, and lower-type ST depression, with inferior ischemia. The sensitivity and specificity of the spatial distribution of ST depression in identifying the myocardial ischemic site were 27% and 95% for anterior ischemia. The sensitivity and specificity of the spatial distribution of St depression in identifying the myocardial ischemic site were 27% and 95% for anterior ischemia respectively, and 28% and 88% for inferior ischemia, respectively. The incidence of U-wave inversion was moderate (29/75, 39%), but the distribution pattern was specific for the site of ischemia; upper-type U inversion associated with anterior ischemia, and lower type with inferior ischemia. The sensitivity and specificity were 59% and 100% for anterior ischemia respectively, and 22% and 100% for inferior ischemia respectively. By a combination of ST-depression and U-inversion, the sensitivity and specificity were 78% and 95% for anterior ischemia, and 44% and 88% for inferior ischemia. Body surface electrocardiographic mapping provided important information in the non-invasive diagnosis of the site of myocardial ischemia.
对75例冠状动脉狭窄（大于或等于70%）且既往无心肌梗死的患者，在症状限制性平板运动前后同时记录87份单极心电图。ST段压低的体表分布分为3种类型：上型、下型和弥漫型。U波倒置的体表分布分为2种类型：上型和下型。将这些分布模式与通过锝-201运动心肌灌注显像确定的缺血部位进行比较。对于ST段压低，无论缺血部位是前壁（22/32，69%）、下壁（18/27，67%）还是两者皆有（5/5，100%），相当数量的患者存在弥漫型ST段压低。然而，上型ST段压低与前壁缺血相关，下型ST段压低与下壁缺血相关。ST段压低空间分布在识别心肌缺血部位方面，对前壁缺血的敏感性和特异性分别为27%和95%。ST段压低空间分布在识别心肌缺血部位方面，对前壁缺血的敏感性和特异性分别为27%和95%，对下壁缺血的敏感性和特异性分别为28%和88%。U波倒置的发生率为中等（29/75，39%），但其分布模式对缺血部位具有特异性；上型U波倒置与前壁缺血相关，下型与下壁缺血相关。对前壁缺血的敏感性和特异性分别为59%和100%，对下壁缺血的敏感性和特异性分别为22%和100%。通过ST段压低和U波倒置相结合，对前壁缺血的敏感性和特异性分别为78%和95%，对下壁缺血的敏感性和特异性分别为44%和88%。体表心电图标测在心肌缺血部位的无创诊断中提供了重要信息。
