Ogawa S, Fujii I, Yoshino H, Tani M, Ohnishi S, Nagata M, Chino M, Handa S, Nakamura Y
Clin Cardiol. 1985 May;8(5):269-75. doi: 10.1002/clc.4960080506.
To investigate the value of the 12-lead ECG and two-dimensional echocardiography (2DE) in the distinction of left circumflex (LCX) from right coronary artery (RCA) disease, we analyzed the location of Q waves, infarct lesions, and coronary artery narrowings in 26 patients with angiographically documented single-vessel disease. Q waves in leads II, III, and aVF were associated with the posterior wall (PW) lesions at the papillary muscle level. Extensive lesions from the PW to the posterior septum (PS) identified RCA disease, while extension to the lateral wall (LW) identified LCX disease. Eleven of 12 patients with high posterior infarction (tall R wave in V1) were found to have extensive LW lesions and 10 of these had coronary narrowings in or proximal to the obtuse marginal branch of LCX. All 6 patients with high posterior infarction and high lateral infarction (Q in I or aVL) had infarct lesions extending from the LW to the anterior wall (AW) and were associated with LCX disease with a large obtuse marginal branch. Of 10 patients with Q waves in V6, the apical LW and PW were involved in 7 and either segment in 3. Nine of these 10 patients had LCX disease. It is concluded that the location of Q waves in inferior infarction could aid in recognizing infarct extension and underlying coronary artery disease.
为研究12导联心电图和二维超声心动图（2DE）在鉴别左回旋支（LCX）病变与右冠状动脉（RCA）病变中的价值，我们分析了26例经血管造影证实为单支血管病变患者的Q波位置、梗死灶及冠状动脉狭窄情况。II、III和aVF导联的Q波与乳头肌水平的后壁（PW）病变相关。从PW至后间隔（PS）的广泛病变提示RCA病变，而延伸至侧壁（LW）则提示LCX病变。12例后壁高位梗死（V1导联R波高大）患者中有11例存在广泛的LW病变，其中10例在LCX的钝缘支或其近端存在冠状动脉狭窄。所有6例后壁高位梗死合并侧壁高位梗死（I或aVL导联出现Q波）的患者，梗死灶从LW延伸至前壁（AW），并与有大钝缘支的LCX病变相关。10例V6导联出现Q波的患者中，7例心尖LW和PW受累，3例其中之一受累。这10例患者中有9例为LCX病变。结论是下壁梗死时Q波的位置有助于识别梗死扩展及潜在的冠状动脉疾病。
