MacLeod R S, Gardner M, Miller R M, Horácek B M
Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City 84112, USA.
J Cardiovasc Electrophysiol. 1995 Jan;6(1):2-18. doi: 10.1111/j.1540-8167.1995.tb00752.x.
Localization of Ischemia. This study demonstrates the utility of an electrocardiographic inverse solution, coupled with body surface potential mapping (BSPM), in localizing acute ischemia in patients undergoing percutaneous transluminal coronary angioplasty (PTCA). PTCA balloon inflations produce complete occlusion and acute transient ischemia, which can be detected electrocardiographically with BSPM. Comparisons between maps recorded both during and before the inflation of the PTCA balloon allow patient- and artery-specific characterizations of the resulting ischemia. Knowledge of the patient's coronary anatomy and the location of the occlusion site by coronary angiography permit an estimation based on cardiac hemodynamics of the region of myocardium most likely to suffer from PTCA-induced ischemia. Electrocardiographic inverse solutions provide a means of predicting cardiac potentials from body surface maps. In this study, we describe an inverse solution we have developed to localize the transient ischemia produced by PTCA. To validate the procedure, we compared the locations of predicted ischemia in seven patients with a qualitative estimate of the perfusion region based on fluoroscopic examination of each patient's coronary anatomy and PTCA balloon location. In each case, the region of ischemia predicted by the model included the perfusion zone determined fluoroscopically. These results suggest that electrical changes induced by acute ischemia can be localized with an electrocardiographic inverse solution.
缺血的定位。本研究证明了心电图逆解结合体表电位标测（BSPM）在经皮腔内冠状动脉成形术（PTCA）患者急性缺血定位中的应用价值。PTCA球囊充盈会导致完全闭塞和急性短暂性缺血，这可通过BSPM进行心电图检测。比较PTCA球囊充盈期间和充盈前记录的图谱，可对由此产生的缺血进行患者特异性和动脉特异性特征分析。通过冠状动脉造影了解患者的冠状动脉解剖结构和闭塞部位，有助于根据心脏血流动力学估计最可能因PTCA诱发缺血的心肌区域。心电图逆解为从体表图谱预测心脏电位提供了一种方法。在本研究中，我们描述了一种已开发的逆解方法，用于定位PTCA产生的短暂性缺血。为验证该方法，我们将7例患者预测缺血的位置与基于对每位患者冠状动脉解剖结构和PTCA球囊位置的荧光透视检查对灌注区域进行的定性估计进行了比较。在每种情况下，模型预测的缺血区域都包括荧光透视确定的灌注区。这些结果表明，急性缺血引起的电变化可用心电图逆解进行定位。
