Dunn R F, Freedman B, Kelly D T, Bailey I K, McLaughlin A
Circulation. 1981 Jun;63(6):1357-63. doi: 10.1161/01.cir.63.6.1357.
Exercise-induced ST-segment elevation in leads V1 and/or aVL in the absence of anterior Q waves occurred in 46 of 190 patients (24%) who underwent 12-lead exercise electrocardiography with thallium-201 myocardial perfusion imaging and coronary arteriography. Significant left anterior descending coronary artery (LAD) disease was present in 38 of 46 patients (83%) with V1/aVL ST evaluation and in 72 of 144 patients (50%) without V1/aVL ST elevation (p less than 0.0005). Anterior myocardial ischemia, indicated by reversible anterior perfusion defects on thallium scanning, was present in 40 of 46 patients (87%) with V1/aVL ST elevation and in 25 of 144 patients (17%) without V1/aVL ST elevation (p less than 0.0005). Exercise ST elevation in V1/aVL was detected in 38 of 110 of the patients (35%) with LAD disease, for a specificity of 90%, and in 40 of 65 of the patients (62%) with anterior myocardial ischemia, for a specificity of 95%. We conclude that during 12-lead exercise electrocardiography, ST-segment elevation in V1 and/or a VL in the absence of anterior Q waves predicts anterior myocardial ischemia and LAD disease.
190例接受了含铊-201心肌灌注显像及冠状动脉造影的12导联运动心电图检查的患者中，46例（24%）在无Q波的情况下出现V1导联和/或aVL导联运动诱发的ST段抬高。在46例出现V1/aVL导联ST段抬高的患者中，38例（83%）存在显著的左前降支冠状动脉（LAD）病变；在144例未出现V1/aVL导联ST段抬高的患者中，72例（50%）存在显著的左前降支冠状动脉病变（p<0.0005）。在46例出现V1/aVL导联ST段抬高的患者中，40例（87%）在铊扫描上有可逆性前壁灌注缺损提示前壁心肌缺血；在144例未出现V1/aVL导联ST段抬高的患者中，25例（17%）有可逆性前壁灌注缺损提示前壁心肌缺血（p<0.0005）。在110例LAD病变患者中，38例（35%）检测到V1/aVL导联运动ST段抬高，特异性为90%；在65例有前壁心肌缺血的患者中，40例（62%）检测到V1/aVL导联运动ST段抬高，特异性为95%。我们得出结论，在12导联运动心电图检查期间，无Q波情况下V1导联和/或aVL导联的ST段抬高可预测前壁心肌缺血和LAD病变。
