Fiol Sala M, Jaume Tomás G, Orellana Mas J, Ibáñez Juvé J, Guardiola Navarro F, García Moris S
Med Clin (Barc). 1981 Sep 25;77(5):195-9.
The electrocardiogram as a diagnostic aid in acute myocardial infarction of the right ventricle (AMI-RV) was studied prospectively in a group of 66 patients in our coronary unit. Diagnosis was AMI in all cases, divided into 29 (44%) with posterior-descending and 35 (53%) with anterior location. Electrocardiography was practiced with standard and special modes: CRnR, CR and VR. Thirty-nine patients were hemodynamically monitored. In 13 patients with posterior-descending location (19.6%) the hemodynamic pattern disclosed AMI. Right ventricular dysfunction was found in 17%, left ventricular dysfunction in 9% and biventricular dysfunction in 20%. In 30 patients (45.5%) ST increased to greater than 1 mm CR3R-CR6R of which 77% were false positive and 46% false negative. No improvement in these proportions was observed with the use of special mode, special in infarctions with anterior location. The correlation between hemodynamics-site of necrosis was better than that between hemodynamics-increase in ST in CRnR. The authors draw the conclusion that special modes as an aid to diagnosis are of limited value, sensitivity is 54% and specificity is 23%, which rises to 50% in posterior-descending infarctions. At present hemodynamics are the choice diagnostic procedure for AMI-RV which must be suspected if serial studies disclose PVC of more than 9 mm Hg.
我们在冠心病监护病房对66例患者进行了前瞻性研究，以探讨心电图在诊断右心室急性心肌梗死（AMI-RV）中的辅助作用。所有病例均诊断为AMI，其中29例（44%）为后降支梗死，35例（53%）为前壁梗死。采用标准模式和特殊模式（CRnR、CR和VR）进行心电图检查。对39例患者进行了血流动力学监测。在13例后降支梗死患者（19.6%）中，血流动力学模式显示为AMI。发现右心室功能障碍者占17%，左心室功能障碍者占9%，双心室功能障碍者占20%。30例患者（45.5%）的CR3R-CR6R导联ST段抬高超过1mm，其中77%为假阳性，46%为假阴性。采用特殊模式后，这些比例并无改善，尤其是在前壁梗死患者中。血流动力学与坏死部位之间的相关性优于血流动力学与CRnR导联ST段抬高之间的相关性。作者得出结论，特殊模式作为诊断辅助手段价值有限，敏感性为54%，特异性为23%，在后降支梗死中特异性升至50%。目前，血流动力学是诊断AMI-RV的首选方法，如果系列研究显示PVC超过9mmHg，则必须怀疑AMI-RV。
