Mukharji J, Murray S, Lewis S E, Croft C H, Corbett J R, Willerson J T, Rude R E
J Am Coll Cardiol. 1984 Jul;4(1):28-34. doi: 10.1016/s0735-1097(84)80314-9.
The hypothesis that anterior ST segment depression represents concomitant posterior infarction was tested in 49 patients admitted with a first transmural inferior myocardial infarction. Anterior ST depression was defined as 0.1 mV or more ST depression in leads V1, V2 or V3 on an electrocardiogram recorded within 18 hours of infarction. Serial vectorcardiograms and technetium pyrophosphate scans were obtained. Eighty percent of the patients (39 of 49) had anterior ST depression. Of these 39 patients, 34% fulfilled vectorcardiographic criteria for posterior infarction, and 60% had pyrophosphate scanning evidence of posterior infarction. Early anterior ST depression was neither highly sensitive (84%) nor specific (20%) for the detection of posterior infarction as defined by pyrophosphate imaging. Of patients with persistent anterior ST depression (greater than 72 hours), 87% had posterior infarction detected by pyrophosphate scan. In patients with inferior myocardial infarction, vectorcardiographic evidence of posterior infarction correlated poorly with pyrophosphate imaging data. Right ventricular infarction was present on pyrophosphate imaging in 40% of patients with pyrophosphate changes of posterior infarction but without vectorcardiographic evidence of posterior infarction. It is concluded that: 1) the majority of patients with acute inferior myocardial infarction have anterior ST segment depression; 2) early anterior ST segment depression in such patients is not a specific marker for posterior infarction; and 3) standard vectorcardiographic criteria for transmural posterior infarction may be inaccurate in patients with concomitant transmural inferior myocardial infarction or right ventricular infarction, or both.
对49例首次发生透壁性下壁心肌梗死入院患者进行了研究，以验证前壁ST段压低代表合并后壁梗死这一假说。前壁ST段压低定义为梗死18小时内记录的心电图上V1、V2或V3导联ST段压低0.1mV或更多。同时进行了系列向量心电图检查和焦磷酸锝扫描。80%的患者（49例中的39例）有前壁ST段压低。在这39例患者中，34%符合后壁梗死的向量心电图标准，60%有焦磷酸扫描显示后壁梗死的证据。按照焦磷酸成像定义，早期前壁ST段压低对检测后壁梗死既不具有高敏感性（84%）也不具有高特异性（20%）。在前壁ST段持续压低（超过72小时）的患者中，87%通过焦磷酸扫描检测到后壁梗死。在下壁心肌梗死患者中，后壁梗死的向量心电图证据与焦磷酸成像数据相关性较差。在有后壁梗死焦磷酸改变但无后壁梗死向量心电图证据的患者中，40%的患者焦磷酸成像显示存在右心室梗死。结论如下：1）大多数急性下壁心肌梗死患者有前壁ST段压低；2）此类患者早期前壁ST段压低并非后壁梗死的特异性标志物；3）对于合并透壁性下壁心肌梗死或右心室梗死或两者皆有的患者，透壁性后壁梗死的标准向量心电图标准可能不准确。
