Department of Cardiology, Maggiore Hospital, Bologna, Italy.
J Cardiovasc Med (Hagerstown). 2018 Aug;19(8):439-445. doi: 10.2459/JCM.0000000000000684.
Left main trunk (LMT) occlusion is a rare angiographic finding. The primary purpose was to investigate the ECG pattern of patients with angiographic confirmation of LMT as culprit lesion.
Forty-eight patients (32 men; mean age 73 years) with angiographic total (21 patients; 44%) or subtotal (27 patients; 56%) occlusion of the LMT were analyzed. Twenty patients (42%) were found to have concomitant coronary lesions. Eighteen patients (38%) required intra-aortic balloon pump support.
A significant left axis deviation was observed in 26 cases (54%) and an intraventricular conduction delay in 32 patients (67%). The average QRS width and QTc interval were 122 and 433 ms, respectively. ST-segment elevation in lead aVR occurred in 32 patients (67%). ST-segment elevation in leads V2-5 and in leads I and aVL [classic left anterior descending (LAD) type] was frequently observed (18 cases; 35%). In six patients (13%), a partial LAD type was observed with ST-segment elevation in leads I and aVL, but not in peripheral leads. The remaining patients showed ST-segment elevation only in peripheral leads (12 cases), in inferior leads III + aVF (six cases), whereas six patients had no ST-segment elevation. Diffuse ST-segment depression only (>6 leads) was observed in 15 cases (31%). Eighteen patients (38%) died during hospitalization.
ST-segment elevation in lead aVR or a LAD-type pattern can be associated with LMT disease. Other relevant aspects are the presence of cardiogenic shock at admission, the left axis deviation and marked prolongation of QTc interval and QRS width.
左主干（LMT）闭塞是一种罕见的血管造影发现。主要目的是研究经血管造影证实为罪犯病变的 LMT 患者的心电图模式。
分析了 48 例（32 例男性；平均年龄 73 岁） LMT 完全（21 例；44%）或次全（27 例；56%）闭塞的患者。20 例（42%）患者合并冠状动脉病变。18 例（38%）患者需要主动脉内球囊泵支持。
26 例（54%）出现明显的左轴偏移，32 例（67%）出现室内传导延迟。平均 QRS 宽度和 QTc 间期分别为 122ms 和 433ms。32 例（67%）患者 aVR 导联 ST 段抬高。V2-5 导联和 I 导联及 aVL 导联 [经典左前降支（LAD）型] ST 段抬高较常见（18 例；35%）。在 6 例患者（13%）中，观察到部分 LAD 型，仅在 I 导联和 aVL 导联出现 ST 段抬高，而在周围导联无 ST 段抬高。其余患者仅在周围导联（12 例）、下壁导联 III+ aVF（6 例）出现 ST 段抬高，而 6 例患者无 ST 段抬高。15 例（31%）仅出现弥漫性 ST 段压低（>6 个导联）。18 例（38%）患者在住院期间死亡。
aVR 导联 ST 段抬高或 LAD 型可与 LMT 病变相关。其他相关方面包括入院时心源性休克、左轴偏移、明显延长的 QTc 间期和 QRS 宽度。
