Gash A K, Warner H F, Zadrozny J H, Carabello B A, Spann J F
Cathet Cardiovasc Diagn. 1985;11(3):223-33. doi: 10.1002/ccd.1810110302.
Subendocardial, nontransmural, or non-Q-wave myocardial infarction (NQM) carries a serious prognosis. Many previous studies of NQMI include only patients without new Q waves at the time of infarction. Since the site of transmural MI (by Q waves) has implications concerning extent of coronary disease (CAD) and left ventricular (LV) dysfunction, we wondered what the extent of CAD and LV dysfunction is among acute MI patients who have neither new nor old Q waves. Furthermore, we sought to determine whether ST-T wave patterns or resting LV ejection fraction (EF), alone or combined, could separate NQMI patients with significant CAD from those with normal or nearly normal coronaries. Therefore, we retrospectively examined angiographic and electrocardiographic data in 55 symptomatic patients with NQMI. ST-T wave patterns on admission were classified as either ischemic (transient ST elevation, persistent horizontal ST depression, or persistent deep T wave inversion) or nonspecific. Eleven patients (20%) had normal or nearly normal coronaries (N); ten patients (18%) had one, seven patients (13%) had two, and 19 patients (34%) had three vessel CAD; eight patients (15%) had left main (LM) disease. Six of the 11 N patients had ergonovine tests and all six were negative. Segmental LV wall motion abnormalities (WMA) were commonly observed; however, diffuse LVWMA were present only among patients with three vessel and LM disease. EF was below 0.50 in 48% of patients with three vessel or LM disease. Although ischemic ST-T wave patterns were more common (P less than 0.05) among patients with significant CAD than among N patients, neither the ST-T wave pattern nor EF, alone or in combination, allowed confident separation of N patients from significant CAD patients. We conclude 1) A large proportion of NQMI patients have LM disease, three vessel disease, or normal or nearly normal coronaries. 2) Despite the absence of Q waves, LV dysfunction is common and the degree of LV impairment is worse among patients with more extensive CAD. 3) NQMI patients who may have normal or nearly normal coronaries cannot be reliably separated from NQMI patients with significant CAD on the basis of ST-T wave patterns or resting LVEF. 4) Coronary angiography appears warranted to assess the extent of CAD in symptomatic NQMI patients.
心内膜下、非透壁性或非Q波心肌梗死（NQM）预后严重。既往许多关于非Q波心肌梗死（NQMI）的研究仅纳入梗死时无新出现Q波的患者。由于透壁性心肌梗死（由Q波定义）的部位与冠状动脉疾病（CAD）范围及左心室（LV）功能障碍相关，我们想了解在既无新Q波也无旧Q波的急性心肌梗死患者中，CAD及LV功能障碍的程度如何。此外，我们试图确定单独或联合的ST - T波形态或静息左心室射血分数（EF）能否将有显著CAD的NQMI患者与冠状动脉正常或接近正常的患者区分开来。因此，我们回顾性分析了55例有症状的NQMI患者的血管造影和心电图数据。入院时的ST - T波形态分为缺血性（短暂性ST段抬高、持续性水平ST段压低或持续性深T波倒置）或非特异性。11例患者（20%）冠状动脉正常或接近正常（N）；10例患者（18%）有单支血管病变，7例患者（13%）有双支血管病变，19例患者（34%）有三支血管病变；8例患者（15%）有左主干（LM）病变。11例N组患者中有6例进行了麦角新碱试验，全部6例结果均为阴性。节段性左心室壁运动异常（WMA）常见；然而，弥漫性左心室壁运动异常仅见于有三支血管病变和左主干病变的患者中。三支血管病变或左主干病变患者中48%的左心室射血分数低于0.50。尽管有显著CAD的患者中缺血性ST - T波形态比N组患者更常见（P < 0.05），但单独或联合的ST - T波形态及EF均不能可靠地将N组患者与有显著CAD的患者区分开来。我们得出以下结论：1）很大一部分NQMI患者有左主干病变、三支血管病变或冠状动脉正常或接近正常。2）尽管没有Q波，左心室功能障碍常见，且CAD范围更广的患者左心室损害程度更严重。3）基于ST - T波形态或静息左心室射血分数，无法可靠地将冠状动脉可能正常或接近正常的NQMI患者与有显著CAD的NQMI患者区分开来。4）对于有症状的NQMI患者，冠状动脉造影似乎有必要用于评估CAD的范围。
