Tzivoni D, Chenzbraun A, Keren A, Benhorin J, Gottlieb S, Lonn E, Stern S
Am J Cardiol. 1985 Jul 1;56(1):23-6. doi: 10.1016/0002-9149(85)90559-4.
If reciprocal electrocardiographic changes during acute myocardial infarction (AMI) are a result of ischemia of the wall opposite the AMI, a stress test is expected to induce similar changes in the corresponding electrocardiographic leads. Right atrial pacing was used as a myocardial stress method in 137 consecutive patients recovering from a transmural AMI, and the appearance of pacing-provoked ischemia before hospital discharge was correlated to the presence of absence of ST depression in the opposite wall during the initial 48 hours. Of the 137 patients, 83 (61%) had reciprocal changes; they were more common in inferior (87%) than in anterior (37%) AMI (p less than 0.01). Of 54 patients without reciprocal changes, only 5 (9%) had ST depression during predischarge pacing; however, of the 83 patients with reciprocal changes, 41 had pacing-induced ischemia (p less than 0.01) and 42 did not, indicating that in half of this group the reciprocal changes represent ischemia of the opposite wall. In the other half of the group, without ST depression during pacing, these changes may be a "mirror image" phenomenon. Follow-up showed that angina pectoris, positive treadmill test response 6 months later, or recurrent AMI all consequences of impaired myocardial blood supply, were significantly more frequent in patients with reciprocal changes. This group could be further separated according to the results of right atrial pacing, because angina pectoris or recurrent AMI were infrequent among those with reciprocal changes and negative pacing responses, but was frequent among those with reciprocal changes and positive pacing responses.(ABSTRACT TRUNCATED AT 250 WORDS)
如果急性心肌梗死（AMI）期间的心电图 reciprocal 改变是 AMI 对侧心肌缺血的结果，那么预计应激试验会在相应的心电图导联中诱发类似改变。在 137 例连续的透壁性 AMI 恢复期患者中，采用右心房起搏作为心肌应激方法，并将出院前起搏诱发的缺血表现与最初 48 小时内对侧心肌壁 ST 段压低的有无相关联。在这 137 例患者中，83 例（61%）有 reciprocal 改变；在下壁 AMI 中更常见（87%），而在前壁 AMI 中为 37%（p<0.01）。在 54 例无 reciprocal 改变的患者中，仅 5 例（9%）在出院前起搏时有 ST 段压低；然而，在 83 例有 reciprocal 改变的患者中，41 例有起搏诱发的缺血（p<0.01），42 例没有，这表明该组中有一半患者的 reciprocal 改变代表对侧心肌壁缺血。在该组的另一半患者中，起搏时无 ST 段压低，这些改变可能是一种“镜像”现象。随访显示，有 reciprocal 改变的患者中，心绞痛、6 个月后平板运动试验阳性反应或复发性 AMI（均为心肌供血受损的后果）明显更常见。根据右心房起搏的结果，该组患者可进一步细分，因为在有 reciprocal 改变且起搏反应阴性的患者中，心绞痛或复发性 AMI 不常见，但在有 reciprocal 改变且起搏反应阳性的患者中则很常见。（摘要截短至 250 字）
