Feldman T, Chua K G, Childers R W
Am J Cardiol. 1986 Nov 1;58(10):885-90. doi: 10.1016/s0002-9149(86)80004-2.
Increases in electrocardiographic R-wave amplitude in humans have been described with positive and negative dynamic exercise test findings, episodes of variant angina and myocardial ischemia and infarction. The role of factors other than acute reversible ischemia in the genesis of these R-wave size alterations is unclear. To evaluate the contribution of acute ischemia to changes in R-wave size in the absence of other confounding variables, electrocardiograms were recorded before and during coronary angioplasty balloon inflation. The frontal leads and V1, V2, V5 and V6 were recorded during the last 10 seconds of coronary occlusion in 20 patients and intracoronary epicardial electrograms were recorded continuously during balloon inflation in 10 patients. Inflations were 8 +/- 2 atm for 52 +/- 36 seconds. Chest pain occurred in 26 of 30 patients with balloon inflation and ST elevation occurred in 22. No significant increases in R amplitude were noted in any lead or in the sum of the R waves in all leads, including intracoronary electrograms. In contrast, R amplitude tended to decrease. The initial decrease in both surface and epicardial R amplitude was similar to the first of the biphasic changes observed in animal models. An increase in R-wave amplitude is not by itself always a marker for myocardial ischemia, but depends on severity and duration of the process.
人类心电图R波振幅增加已被描述与动态运动试验的阳性和阴性结果、变异型心绞痛发作以及心肌缺血和梗死有关。除急性可逆性缺血外，其他因素在这些R波大小改变发生过程中的作用尚不清楚。为了评估在不存在其他混杂变量的情况下急性缺血对R波大小变化的影响，在冠状动脉血管成形术球囊扩张前和扩张期间记录心电图。在20例患者冠状动脉闭塞的最后10秒记录额面导联以及V1、V2、V5和V6导联，在10例患者球囊扩张期间连续记录心内膜下心电图。球囊充气压力为8±2个大气压，持续52±36秒。30例进行球囊扩张的患者中有26例出现胸痛，22例出现ST段抬高。在任何导联或所有导联R波总和（包括心内膜下心电图）中均未观察到R波振幅有显著增加。相反，R波振幅有下降趋势。体表和心内膜下R波振幅的初始下降与在动物模型中观察到的双相变化的第一阶段相似。R波振幅增加本身并不总是心肌缺血的标志，而是取决于该过程的严重程度和持续时间。
