Ogino K, Fukugi M, Hirai S, Kinugawa T, Hoshio A, Hasegawa J, Kotake H, Mashiba H
First Department of Internal Medicine, Tottori University School of Medicine, Yonago, Japan.
Clin Cardiol. 1988 Feb;11(2):101-4. doi: 10.1002/clc.4960110208.
The QRS axis of 101 patients with coronary artery disease (CAD) and 57 normal subjects without CAD who underwent coronary arteriograms were measured before and after exercise testing. There was no improvement in the sensitivity of positive axis shifts (15 degrees or greater) for CAD (18%) when compared to the value of positive ST depression (61%). However, the specificity of positive axis shifts for CAD was significantly increased (98%) when compared to the value of positive ST depression (77%). In addition, 39% of those patients with CAD (39 of 101) showed false negative ST depression, but 18% of these patients (7 of 39) showed a positive axis shift. In normal subjects 21% (12 of 57) showed false positive ST depression, but all of the 21% (12 of 12) showed negative axis shift. There was no significant difference in the increments of heart rate between positive ST depression, positive axis shift, and negative ST depression, negative axis shift. No statistical differences in the sensitivity of ST depression and an axis shift for one-, two- and three-vessel diseases were noted. The specificity of left-axis shift for the left anterior descending artery lesion was 98% and the specificity of right-axis shift for the right coronary artery and/or left circumflex artery lesion was 91%. Therefore, the axis shift response is no more sensitive for the detection of CAD than ST depression. However, when a positive axis shift is observed, one can predict two things: the CAD and the localization of the coronary stenosis.
对101例冠心病（CAD）患者和57例未患CAD的正常受试者进行了冠状动脉造影，并在运动试验前后测量了他们的QRS轴。与ST段压低阳性率（61%）相比，CAD患者轴偏移阳性（15度或更大）的敏感性没有提高（18%）。然而，与ST段压低阳性率（77%）相比，CAD患者轴偏移阳性的特异性显著提高（98%）。此外，39%的CAD患者（101例中的39例）出现了ST段压低假阴性，但其中18%（39例中的7例）出现了轴偏移阳性。在正常受试者中，21%（57例中的12例）出现了ST段压低假阳性，但所有这些假阳性受试者（12例中的12例）均出现轴偏移阴性。ST段压低阳性、轴偏移阳性与ST段压低阴性、轴偏移阴性之间的心率增量无显著差异。未发现ST段压低和轴偏移对单支、双支和三支血管病变的敏感性存在统计学差异。左前降支病变左轴偏移的特异性为98%，右冠状动脉和/或左旋支病变右轴偏移的特异性为91%。因此，轴偏移反应在检测CAD方面并不比ST段压低更敏感。然而，当观察到轴偏移阳性时，可以预测两件事：CAD以及冠状动脉狭窄的部位。
