Hellerstedt M, Jonasson R, Orinius E
Acta Med Scand. 1980;208(3):213-7. doi: 10.1111/j.0954-6820.1980.tb01180.x.
To find electrocardiographic criteria for ventricular septal infarction, two series of ECGs were studied, all without fascicular/bundle branch block and complete heart block. One series consisted of the ECGs recorded at thallium-201 scintigraphy in 49 patients 2-3 weeks after an acute myocardial infarction (AMI): in this series the 14 patients with a defect in the septal wall of the left anterior oblique view were compared with the 35 without. The other series consisted of the last premortal ECGs in 20 AMI patients with and in seven without a septal involvement of the infarct at autopsy. The best criterion from earlier literature ws absence of a q wave in lead V6, showing a sensitivity of 53% in the combined scintigraphy and autopsy series. The predictive value of a positive test was 75%. The very first QRS vector in the frontal plane tended to discriminate better than absence of a q in lead V6. With a similar predictive value, 71%, the sensitivity of a deviating vector (+ 120 degrees to -60 degrees and -120 degrees to -180 degrees) was 65% in the combined scintigraphy and autopsy groups. Most of the patients with a deviating vector showed this on admission. The clinical importance of an early diagnosis of septal involvement in AMI remains to be settled.
为了找到室间隔梗死的心电图标准，研究了两组心电图，所有病例均无束支/分支阻滞及完全性心脏传导阻滞。一组包括49例急性心肌梗死（AMI）后2 - 3周行铊-201心肌显像时记录的心电图：该组中，14例左前斜位显示室间隔壁有缺损的患者与35例无缺损的患者进行了比较。另一组包括20例AMI患者生前最后一份心电图，其中7例尸检时梗死灶未累及室间隔，另外13例累及室间隔。早期文献中最佳的标准是V6导联无q波，在心肌显像和尸检联合系列研究中显示敏感性为53%。阳性试验的预测值为75%。额面初始QRS向量比V6导联无q波的鉴别能力更强。在联合心肌显像和尸检组中，偏移向量（+120度至-60度和-120度至-180度）的敏感性为65%，预测值相似，为71%。大多数有偏移向量的患者在入院时即表现出这一特征。AMI时早期诊断室间隔受累的临床重要性仍有待确定。
