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左主干冠状动脉疾病：心电图被遗忘的导联具有预测价值。

Left Main Coronary Artery Disease: The Forgotten Lead of Electrocardiogram Is Predictive.

作者信息

Bhattad Pradnya Brijmohan, Sherif Akil A, Mishra Ajay K, Roumia Mazen

机构信息

Cardiovascular Medicine, Saint Vincent Hospital, University of Massachusetts (UMass) Chan Medical School, Worcester, USA.

出版信息

Cureus. 2022 Aug 25;14(8):e28391. doi: 10.7759/cureus.28391. eCollection 2022 Aug.

DOI:10.7759/cureus.28391
PMID:36168367
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9506673/
Abstract

An ST segment depression in eight or more leads along with ST segment elevation in lead aVR or V1, especially occurring during ischemic symptoms, has a very high predictive accuracy of left main or three-vessel disease, or tight proximal left anterior descending (LAD) coronary artery stenosis. We describe a classic case of a patient who presented with ST elevation in the lead aVR with diffuse ST segment depression during anginal symptoms and was found to have severe disease in the distal left main, ostial circumflex, and left anterior descending artery on an emergent coronary angiogram.

摘要

八个或更多导联出现ST段压低，同时aVR或V1导联出现ST段抬高，尤其是在缺血症状发作时出现，对左主干或三支血管病变，或左前降支（LAD）近端严重冠状动脉狭窄具有很高的预测准确性。我们描述了一例典型病例，该患者在心绞痛症状发作时aVR导联出现ST段抬高，伴有弥漫性ST段压低，急诊冠状动脉血管造影显示左主干远端、回旋支开口处和左前降支严重病变。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1859/9506673/7a36c5a6adaa/cureus-0014-00000028391-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1859/9506673/7a36c5a6adaa/cureus-0014-00000028391-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1859/9506673/7a36c5a6adaa/cureus-0014-00000028391-i01.jpg

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本文引用的文献

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Value of ST-segment change in lead aVR in diagnosing left main disease in Non-ST-elevation acute coronary syndrome-A meta-analysis.aVR导联ST段改变在诊断非ST段抬高型急性冠状动脉综合征左主干病变中的价值——一项荟萃分析
Ann Noninvasive Electrocardiol. 2019 Nov;24(6):e12692. doi: 10.1111/anec.12692. Epub 2019 Sep 18.
2
Short- and long-term prognostic significance of ST-segment elevation in lead aVR in patients with non-ST-segment elevation acute coronary syndrome.aVR 导联 ST 段抬高对非 ST 段抬高型急性冠状动脉综合征患者短期和长期预后的意义。
Am J Cardiol. 2011 Jul 1;108(1):21-8. doi: 10.1016/j.amjcard.2011.02.341. Epub 2011 Apr 27.
3
Combined prognostic utility of ST segment in lead aVR and troponin T on admission in non-ST-segment elevation acute coronary syndromes.
aVR导联ST段与入院时肌钙蛋白T联合应用对非ST段抬高型急性冠脉综合征的预后评估价值
Am J Cardiol. 2006 Feb 1;97(3):334-9. doi: 10.1016/j.amjcard.2005.08.049.
4
Predictors of left main or three-vessel disease in patients who have acute coronary syndromes with non-ST-segment elevation.非ST段抬高型急性冠脉综合征患者左主干或三支血管病变的预测因素
Am J Cardiol. 2005 Jun 1;95(11):1366-9. doi: 10.1016/j.amjcard.2005.01.085.
5
Prediction of acute left main coronary artery obstruction by 12-lead electrocardiography. ST segment elevation in lead aVR with less ST segment elevation in lead V(1).通过12导联心电图预测急性左主干冠状动脉阻塞。aVR导联ST段抬高且V1导联ST段抬高程度较轻。
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6
Value of the electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery in acute anterior myocardial infarction.心电图在急性前壁心肌梗死中定位左前降支冠状动脉闭塞部位的价值。
J Am Coll Cardiol. 1999 Aug;34(2):389-95. doi: 10.1016/s0735-1097(99)00197-7.