Li Yuechun, Zhe-Wei Shi, Cheng Zheng, Guang-Yi Chen, De-Pu Zhou, Xiao-Wei Li, Xueqiang Guan, Jiafeng Lin, Peng Chen
Department of Cardiology, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China.
Medicine (Baltimore). 2017 May;96(21):e7007. doi: 10.1097/MD.0000000000007007.
The purpose of this study was to explore the clinical and electrocardiographic characteristics of infarctional ventricular ectopic beats (IVEBs).Thirty-eight acute myocardial infarction (AMI) patients with IVEB and 109 AMI patients without IVEB were analyzed. The morphological changes of QRS complex, ST segment, and T wave were compared to IVEB with sinus rhythm from the same period and fully evolved phase.An IVEB QRS complex often revealed the right bundle branch block morphology, in addition to Q wave AMI; no-Q wave AMI also had IVEB. Single-factor analysis found that IVEB often appeared in early AMI (<6 hours), and they were more frequent in inferoposterior with/without right ventricular involvement, large area AMI and thrombolytic reperfusion than in anterior or anteroseptal myocardial infarction, small area AMI, and unthrombolytic nonreperfusion. Multifactors no conditional logistic regression analysis revealed a positive correlation between IVEB and early AMI, AMI size, Killip heart function degree, inferoposterior with/without right ventricular involvement, and thrombolytic reperfusion. The Q wave of IVEB was wider, and the ST segment elevation was higher than those of the same period in sinus rhythms. The infarctional morphological changes of IVEB could be found before the same period in sinus rhythm and elevated myocardial enzymes.IVEBs were not rare. They were useful for early diagnosis and location of AMI.
本研究旨在探讨梗死性室性早搏（IVEB）的临床及心电图特征。分析了38例有IVEB的急性心肌梗死（AMI）患者和109例无IVEB的AMI患者。将QRS波群、ST段和T波的形态变化与同期及完全演变期窦性心律的IVEB进行比较。IVEB的QRS波群除Q波型AMI外常呈右束支阻滞形态；非Q波型AMI也有IVEB。单因素分析发现，IVEB常出现在AMI早期（<6小时），在下后壁伴或不伴右心室受累、大面积AMI和溶栓再灌注时比在前壁或前间壁心肌梗死、小面积AMI及未溶栓未再灌注时更常见。多因素非条件logistic回归分析显示，IVEB与AMI早期、AMI面积、Killip心功能分级、下后壁伴或不伴右心室受累及溶栓再灌注呈正相关。IVEB的Q波更宽，ST段抬高高于同期窦性心律。IVEB的梗死形态学改变可在同期窦性心律及心肌酶升高之前出现。IVEB并不罕见。它们对AMI的早期诊断和定位有用。
