Kindwall K E, Brown J P, Josephson M E
Am J Cardiol. 1986 Jun 1;57(15):1255-60. doi: 10.1016/0002-9149(86)90199-2.
Sensitivity, specificity and predictive accuracy of 5 electrocardiographic criteria for chronic myocardial infarction (MI) in the presence of left bundle branch block (LBBB) were evaluated in 47 patients with known (clinical and electrocardiographic Q wave) MI and 28 patients without MI. Two right ventricular sites were paced (producing LBBB with normal or left axis). The effect of infarct location on these criteria was also evaluated. In patients with LBBB: Cabrera's sign (notching of the upstroke of S wave in V3,4,5) is seen more often with MI than without (anterior more often than inferior), and the left axis increased its sensitivity. Chapman's sign (notching of upstroke of the R wave in I, L or V6) is more common in patients without MI, and its specificity and sensitivity are not altered by axis. Sensitivity of notching in 2, 3, F is too low to be clinically useful. Q 2, 3, F indicates only left axis; predictive accuracy for MI is high (100%) only for normal axis where sensitivity is low (3%). (5) Q 1, L, V6 is no more frequent with MI than without, but if MI is present it is more common in anterior than inferior infarction. Specificity and predictive accuracy are too low to be clinically useful as indicators of MI.
在47例已知患有（临床及心电图Q波）心肌梗死（MI）的患者和28例无心肌梗死的患者中，评估了5种心电图标准对存在左束支传导阻滞（LBBB）时慢性心肌梗死的敏感性、特异性和预测准确性。对两个右心室部位进行起搏（产生正常或左偏轴的左束支传导阻滞）。还评估了梗死部位对这些标准的影响。在左束支传导阻滞患者中：卡布雷拉征（V3、V4、V5导联S波上升支切迹）在心肌梗死患者中比无心肌梗死患者更常见（前壁梗死比下壁梗死更常见），且左偏轴增加了其敏感性。查普曼征（I、L或V6导联R波上升支切迹）在无心肌梗死患者中更常见，其特异性和敏感性不受电轴影响。2、3、F导联切迹的敏感性过低，临床应用价值不大。Q 2、3、F仅提示左偏轴；仅在电轴正常时，其对心肌梗死的预测准确性高（100%），但敏感性低（3%）。（5）Q 1、L、V6在心肌梗死患者中并不比无心肌梗死患者更常见，但如果存在心肌梗死，在前壁梗死中比下壁梗死更常见。其特异性和预测准确性过低，作为心肌梗死的指标临床应用价值不大。
