Allencherril Joseph, Fakhri Yama, Engblom Henrik, Heiberg Einar, Carlsson Marcus, Dubois-Rande Jean-Luc, Halvorsen Sigrun, Hall Trygve S, Larsen Alf-Inge, Jensen Svend Eggert, Arheden Hakan, Atar Dan, Clemmensen Peter, Ripa Maria Sejersten, Birnbaum Yochai
Section of Cardiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA.
Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Medicine, Nykøbing F Hospital, Nykøbing F, Denmark.
J Electrocardiol. 2018 Jul-Aug;51(4):563-568. doi: 10.1016/j.jelectrocard.2018.03.016. Epub 2018 Apr 4.
Anteroseptal ST elevation myocardial infarction (STEMI) is traditionally defined on the electrocardiogram (ECG) by ST elevation (STE) in leads V1-V3, with or without involvement of lead V4. It is commonly taught that such infarcts affect the basal anteroseptal myocardial segment. While there are suggestions in the literature that Q waves limited to V1-V4 represent predominantly apical infarction, none have evaluated anteroseptal ST elevation territories. We compared the distribution of the myocardium at risk (MaR) in STEMI patients presenting with STE limited to V1-V4 and those with more extensive STE (V1-V6).
We identified patients in the MITOCARE study presenting with a first acute STEMI and new STE in at least two contiguous anterior leads from V1 to V6. Patients underwent cardiac magnetic resonance (CMR) imaging three to five days after acute infarction.
Thirty-two patients met inclusion criteria. In patients with STE in V1-V4 (n = 20), myocardium at risk (MaR) > 50% was seen in 0%, 85%, 75%, 100%, and 90% in the basal anteroseptal, mid anteroseptal, apical anterior, apical septal segments, and apex, respectively. The group with STE in V1-V6 (n = 12), MaR > 50% was seen in 8%, 83%, 83%, 92%, and 83% of the same segments.
Patients with acute STEMI and STE in leads V1-V4, exhibit MaR in predominantly apical territories and rarely in the basal anteroseptum. We found no evidence to support existence of isolated basal anteroseptal or septal STEMI. "Anteroapical" infarction is a more precise description than "anteroseptal" infarction for acute STEMI patients exhibiting STE in V1-V4.
前间隔ST段抬高型心肌梗死（STEMI）传统上在心电图（ECG）上定义为V1 - V3导联ST段抬高（STE），伴或不伴有V4导联受累。通常认为此类梗死影响基底前间隔心肌节段。虽然文献中有提示，局限于V1 - V4导联的Q波主要代表心尖部梗死，但尚无研究评估前间隔ST段抬高区域。我们比较了ST段抬高局限于V1 - V4导联的STEMI患者与ST段抬高范围更广（V1 - V6）的STEMI患者心肌梗死风险区域（MaR）的分布情况。
我们在MITOCARE研究中识别出首次发生急性STEMI且在至少两个相邻前壁导联（V1至V6）出现新的ST段抬高的患者。患者在急性梗死后三至五天接受心脏磁共振（CMR）成像检查。
32例患者符合纳入标准。在V1 - V4导联ST段抬高的患者（n = 20）中，基底前间隔、中间前间隔、心尖前壁、心尖间隔节段和心尖部的心肌梗死风险区域（MaR）> 50%的比例分别为0%、85%、75%、100%和90%。在V1 - V6导联ST段抬高的患者组（n = 12）中，相同节段的MaR > 50%的比例分别为8%、83%、83%、92%和83%。
急性STEMI且V1 - V4导联ST段抬高的患者，心肌梗死风险区域主要在心尖部，很少在基底前间隔。我们没有发现证据支持孤立的基底前间隔或间隔STEMI的存在。对于在V1 - V4导联出现ST段抬高的急性STEMI患者，“前心尖部”梗死比“前间隔”梗死是更准确的描述。
