David D, Kitchen J G, Michelson E L, Naito M, Sawin H S, Chen C C
Am Heart J. 1984 Jan;107(1):53-61. doi: 10.1016/0002-8703(84)90133-9.
Atrial pacing-induced changes in the sum of R-wave amplitude were measured in leads V5, X, Y, and Z at rates of 100 bpm (phase I), 150 bpm (phase II), and immediately after pacing (phase III) in 33 patients undergoing cardiac catheterization for evaluation of chest pain. Seventeen (51%) patients showed evidence of ischemia during atrial pacing (typical anginal pain and/or at least a 1 mm ST-segment depression) and 16 (49%) showed no evidence of ischemia. Mean R-wave amplitude changes from baseline in the ischemic patients were: phase I: -8% (p = not significant), phase II: +3% (p = not significant), and phase III: +13% (p less than 0.01); and in nonischemic patients: phase I: -11% (p less than 0.02), phase II: -18% (p less than 0.01), and phase III: +2% (p = not significant). These two distinct patterns of R-wave amplitude changes were highly sensitive (85%), specific (92%), and predictive (92%) for identifying patients with myocardial ischemia but did not correlate (p = not significant) with either the angiographically determined extent of coronary artery obstructive disease (CAD), resting left ventricular function, or the dynamic, atrial pacing-induced changes in left ventricular dimensions determined by M-mode and two-dimensional echocardiography. Thus, R-wave amplitude changes induced by atrial pacing can be used to identify patients with myocardial ischemia independent of coronary anatomy or resting left ventricular function.(ABSTRACT TRUNCATED AT 250 WORDS)
在33例因胸痛接受心导管检查的患者中，于V5、X、Y和Z导联测量心房起搏诱发的R波振幅总和变化，起搏频率分别为100次/分钟（I期）、150次/分钟（II期）以及起搏结束后即刻（III期）。17例（51%）患者在心房起搏期间出现缺血证据（典型心绞痛和/或至少1毫米ST段压低），16例（49%）未出现缺血证据。缺血患者R波振幅相对于基线的平均变化为：I期：-8%（p = 无统计学意义），II期：+3%（p = 无统计学意义），III期：+13%（p < 0.01）；非缺血患者为：I期：-11%（p < 0.02），II期：-18%（p < 0.01），III期：+2%（p = 无统计学意义）。这两种不同的R波振幅变化模式对于识别心肌缺血患者具有高度敏感性（85%）、特异性（92%）和预测性（92%），但与血管造影确定的冠状动脉阻塞性疾病（CAD）程度、静息左心室功能或M型和二维超声心动图测定的心房起搏诱发的左心室尺寸动态变化均无相关性（p = 无统计学意义）。因此，心房起搏诱发的R波振幅变化可用于识别心肌缺血患者，而与冠状动脉解剖结构或静息左心室功能无关。（摘要截断于250字）
