Jia Xiaoming, Heiberg Einar, Ripa Maria Sejersten, Engblom Henrik, Halvorsen Sigrun, Arheden Håkan, Atar Dan, Clemmensen Peter, Birnbaum Yochai
a Department of Medicine, Section of Cardiology , Baylor College of Medicine , Houston , TX , USA.
b Department of Clinical Physiology , Lund University and Lund University Hospital , Lund , Sweden.
Scand Cardiovasc J. 2018 Aug;52(4):189-195. doi: 10.1080/14017431.2018.1458145. Epub 2018 Mar 29.
We aim to determine the correlation between ST-segment changes in leads V4-V6 and the extent of myocardial injury by cardiac magnetic resonance (CMR) in patients with inferior ST elevation (STE) myocardial infarction (iSTEMI).
Admission electrocardiogram and CMR data from the MITOCARE trial were used. Differences in mean myocardium at risk, infarct size, ejection fraction and myocardial segment involvement by CMR were compared in patients with first iSTEMI with STE, ST depression (STD) or no ST changes (NST) in V4-V6. Myocardial segment involvement was further evaluated by comparing proportion of patients in each group with ≥25% and ≥50% segment involvement.
Fifty-four patients were included. Patients with STE (n = 22) and STD (n = 16) in V4-V6 had significantly lower ejection fraction compared to NST (n = 16) (48% vs 48% vs 54%, p = .02). STE showed more apical, apical lateral and mid-inferolateral involvement but less basal inferior involvement than NST. STD exhibited greater basal inferoseptal involvement compared to STE. There were more patients with STE that had ≥25% and ≥50% apical lateral involvement compared with STD and NST groups. Patients with STD were more likely to have ≥25% and ≥50% basal inferoseptal involvement compared with STE and NST groups.
Our study suggests that in iSTEMI, ST changes in the precordial leads V4-V6 correlates with greater myocardial injury and distribution of myocardium at risk.
我们旨在确定下壁ST段抬高型心肌梗死（iSTEMI）患者中，V4-V6导联ST段变化与心脏磁共振成像（CMR）评估的心肌损伤程度之间的相关性。
使用了MITOCARE试验中的入院心电图和CMR数据。比较首次发生iSTEMI且V4-V6导联出现ST段抬高（STE）、ST段压低（STD）或无ST段变化（NST）的患者，CMR所评估的平均危险心肌、梗死面积、射血分数及心肌节段受累情况的差异。通过比较每组中节段受累≥25%和≥50%的患者比例，进一步评估心肌节段受累情况。
纳入54例患者。V4-V6导联出现STE（n = 22）和STD（n = 16）的患者，其射血分数显著低于NST组（n = 16）（48%对48%对54%，p = 0.02）。与NST组相比，STE组的心尖部、心尖侧壁及中-下侧壁受累更多，但基底下部受累更少。与STE组相比，STD组的基底-下间隔受累更多。与STD组和NST组相比，STE组中有更多患者的心尖侧壁受累≥25%和≥50%。与STE组和NST组相比，STD组更有可能出现基底-下间隔受累≥25%和≥50%。
我们的研究表明，在iSTEMI中，胸前导联V4-V6的ST段变化与更严重的心肌损伤及危险心肌分布相关。
