Carson W, Tseng Y Z, Tseng C D, Huang P J, Wu T L
Department of Medicine, National Taiwan University Hospital, Taipei, Republic of China.
Eur Heart J. 1988 Sep;9(9):955-61. doi: 10.1093/oxfordjournals.eurheartj.a062600.
Based on serial vectorcardiographic and cardiac scintigraphic studies of 62 patients with acute myocardial infarction, we propose vectorcardiographic criteria for the diagnosis of acute right ventricular infarction. These criteria are: (1) the direction of the maximal spatial ST vector points either to the right-anterior-inferior or to the right-posterior-inferior octant, and (2) the magnitude of the projection of the maximal spatial ST vector is greater than or equal to 0.15 mV in the horizontal plane. By using these criteria correlated with scintigraphic results, 92% sensitivity was achieved together with 98% specificity; the Kappa statistic was 0.90. In patients with acute inferior and right ventricular infarction, the serial maximal spatial ST vector swung to-and-fro like a 'tug of war' between right-anterior-inferior and right-posterior-inferior octants during the acute stage. In patients with acute inferior-posterior and right ventricular infarction, the serial maximal spatial ST vector pointed to the right-posterior-inferior octant during the whole course of the acute stage. Failure to recognize this electrical phenomenon may make the clinician inaccurate when judging the clinical course of acute right ventricular infarction or over-estimate the result of therapeutic intervention.
基于对62例急性心肌梗死患者的系列心电向量图和心脏闪烁扫描研究，我们提出了诊断急性右心室梗死的心电向量图标准。这些标准是：（1）最大空间ST向量的方向指向右前下或右后下象限，以及（2）最大空间ST向量在水平面的投影幅度大于或等于0.15mV。通过使用这些与闪烁扫描结果相关的标准，灵敏度达到了92%，特异性为98%；Kappa统计量为0.90。在急性下壁和右心室梗死患者中，急性期系列最大空间ST向量在右前下和右后下象限之间像“拔河”一样来回摆动。在急性下后壁和右心室梗死患者中，急性期整个过程中系列最大空间ST向量指向右后下象限。未能识别这种电现象可能会使临床医生在判断急性右心室梗死的临床过程时出现偏差，或高估治疗干预的结果。
