Engel T R, Shah R, DePodesta L A, Frankl W S, Krause R L
Ann Intern Med. 1978 Aug;89(2):204-6. doi: 10.7326/0003-4819-89-2-204.
Ischemia is traditionally considered a cause of intermittent left bundle-branch block (LBBB), and some patients have right precordial T-wave inversion in the normally conducted beats. Clinical correlates of T-wave abnormalities were examined in 46 consecutive patients with intermittent LBBB. Thirty-three patients (72%) had at least transient right precordial (V-14) T-wave inversion suggesting ischemia in normally conducted beats. Seventeen such patients had no evidence of coronary heart disease, including five with normal arteriograms. During LBBB conduction, T-wave abnormalities (upright T-waves I, aVL, V5-6) were frequent (48%) and more common than among patients with permanent LBBB (p less than 0.005). The T-wave abnormalities during LBBB conduction occurred in the absence of coronary heart disease in nine patients, including two with normal arteriograms. Thus, right precordial T-wave inversion may result from recent LBBB itself, associated with T-wave abnormalities during the LBBB, in the absence of coronary artery disease.
传统上认为缺血是间歇性左束支传导阻滞（LBBB）的一个病因，并且一些患者在正常传导的心搏中出现右胸前导联T波倒置。对46例连续性间歇性LBBB患者的T波异常的临床相关因素进行了研究。33例患者（72%）至少有短暂的右胸前导联（V1-4）T波倒置，提示正常传导的心搏存在缺血。17例此类患者无冠心病证据，其中5例血管造影正常。在LBBB传导期间，T波异常（I、aVL、V5-6导联T波直立）很常见（48%），且比永久性LBBB患者更常见（p<0.005）。9例患者在LBBB传导期间出现T波异常，且无冠心病，其中2例血管造影正常。因此，在无冠状动脉疾病的情况下，右胸前导联T波倒置可能是近期LBBB本身所致，并伴有LBBB期间的T波异常。
