Warner R A, Hill N E, Mookherjee S, Smulyan H
Am J Cardiol. 1986 Sep 1;58(6):431-5. doi: 10.1016/0002-9149(86)90010-x.
To determine the diagnostic significance for coronary artery disease of abnormally large Q waves in leads I, aVL, V5 and V6--the "lateral" electrocardiographic leads--the electrocardiograms of 240 patients who had undergone cardiac catheterization were studied. First, the electrocardiograms of 99 subjects proved normal by cardiac catheterization (group 1) were studied to determine the values of the durations of Q waves in leads I, aVL, V5 and V6 that should be exceeded to be considered abnormal. These values were 30, 30, 20 and 25 ms, respectively. Then, 67 patients were identified who had abnormal Q waves in at least 1 of these leads (group 2) and 74 patients with at least 1 angiographic abnormality but without abnormal Q waves in any of these leads (group 3). Group 2 had generally more extensive left ventricular disease and a higher prevalence of anterior, inferior and apical healed myocardial infarction (MI) than group 3. However, compared with group 3, group 2 had lower prevalences of significant narrowing of the coronary arteries that supply the left ventricular lateral wall. Within group 2, abnormal Q waves in leads I and aVL (traditionally designated high lateral MI) were associated with anterior as well as apical MI, and abnormal Q waves in leads V5 and V6 (traditionally designated anterolateral MI) were associated with inferior as well as apical MI. Thus, abnormal Q waves in leads I, aVL, V5 and V6 tend to reflect apical rather than lateral MI and the term anterolateral MI is especially misleading.
为了确定心电图I、aVL、V5和V6导联（即“侧壁”导联）出现异常大Q波对冠心病的诊断意义，我们研究了240例接受过心导管检查患者的心电图。首先，研究了99例经心导管检查证实心电图正常的受试者（第1组），以确定I、aVL、V5和V6导联Q波持续时间超过何值时应被视为异常。这些值分别为30、30、20和25毫秒。然后，确定了67例至少在这些导联中的1个导联出现异常Q波的患者（第2组）和74例至少有1处血管造影异常但在这些导联中均无异常Q波的患者（第3组）。第2组的左心室疾病通常更广泛，前壁、下壁和心尖部陈旧性心肌梗死（MI）的患病率高于第3组。然而，与第3组相比，第2组中供应左心室侧壁的冠状动脉严重狭窄的患病率较低。在第2组中，I和aVL导联的异常Q波（传统上称为高位侧壁MI）与前壁和心尖部MI相关，V5和V6导联的异常Q波（传统上称为前侧壁MI）与下壁和心尖部MI相关。因此，I、aVL、V5和V6导联的异常Q波倾向于反映心尖部而非侧壁MI，“前侧壁MI”这一术语尤其具有误导性。
