Zehender M, Kasper W, Kauder E, Schönthaler M, Geibel A, Olschewski M, Just H
Innere Medizin III, Kardiologie, Universitätsklinik Freiburg.
Med Klin (Munich). 1994 Jul 15;89(7):351-9.
Acute inferior myocardial infarction frequently involves the right ventricle (RV). However, very little is known on the prognostic impact of RV involvement in the in-hospital and longterm course, as well as on reliable diagnostic strategies to identify RV infarction early after admission.
In 200 consecutive patients with acute inferior myocardial infarction, we assessed on admission the prevalence and diagnostic accuracy of ST elevation in lead V4R to determine RV involvement, as well as its prognostic implications for in-hospital complications, early and late mortality and the benefit of thrombolytic therapy. Follow-up period was one to six years (mean +/- SD, 37 +/- 12 months).
In-hospital mortality after inferior myocardial infarction was 19%, major complications occurred in 47% of patients. Presence of ST-segment elevation in V4R in 107 patients (54%) was highly predictive of RV infarction (sensitivity: 88%, specificity: 78%, diagnostic efficiency: 83%) and increased the in-hospital mortality rate from 6% to 31% (p < 0.0001) and major in-hospital complications from 28% to 64% (p < 0.0001). Cox regression analysis showed ST elevation in V4R to be independent of and superior to all other clinical variables available at the time of admission (additional risk for in-hospital mortality: 7.7; for major complications: 4.7). Thrombolysis was associated with a reduced mortality (3.7 times, p < 0.0005) and complication rate (2.4 times, p < 0.0001) only in patients with RV infarction. Post-hospital course was similar in patients with and without RV infarction.
RV involvement during acute inferior myocardial infarction, accurately diagnosed by ST-segment elevation in V4R, is a strong, independent parameter for mortality and major in-hospital complications and may help to identify patients who will benefit most from thrombolytic therapy. Electrocardiographic assessment of RV infarction should be routinely performed in all patients admitted with acute inferior myocardial infarction.
急性下壁心肌梗死常累及右心室（RV）。然而，关于右心室受累对住院期间和长期病程的预后影响，以及入院后早期识别右心室梗死的可靠诊断策略，人们了解甚少。
在连续200例急性下壁心肌梗死患者中，我们在入院时评估V4R导联ST段抬高的发生率和诊断准确性，以确定右心室受累情况，及其对住院并发症、早期和晚期死亡率的预后影响，以及溶栓治疗的益处。随访期为1至6年（平均±标准差，37±12个月）。
下壁心肌梗死后的住院死亡率为19%，47%的患者发生了主要并发症。107例患者（54%）V4R导联出现ST段抬高高度提示右心室梗死（敏感性：88%，特异性：78%，诊断效率：83%），并使住院死亡率从6%增至31%（p<0.0001），住院主要并发症从28%增至64%（p<0.0001）。Cox回归分析显示，V4R导联ST段抬高独立于入院时所有其他临床变量，且优于这些变量（住院死亡率额外风险：7.7；主要并发症额外风险：4.7）。仅在右心室梗死患者中，溶栓治疗与死亡率降低（3.7倍，p<0.0005）和并发症发生率降低（2.4倍，p<0.0001）相关。有或无右心室梗死患者的院后病程相似。
急性下壁心肌梗死期间右心室受累，通过V4R导联ST段抬高准确诊断，是死亡率和住院主要并发症的一个强有力的独立参数，可能有助于识别最能从溶栓治疗中获益的患者。对于所有因急性下壁心肌梗死入院的患者，应常规进行右心室梗死的心电图评估。
