Iwasaki K, Kusachi S, Kita T, Taniguchi G
Cardiovascular Center, Sakakibara Hospital, Okayama, Japan.
J Am Coll Cardiol. 1994 Jun;23(7):1557-61. doi: 10.1016/0735-1097(94)90656-4.
This study was performed to determine electrocardiographic (ECG) features that could distinguish first diagonal branch occlusion from left anterior descending coronary artery occlusion.
The ECG findings associated with first diagonal branch obstruction have not previously been compared with those of left anterior descending coronary artery obstruction.
The ECG findings in 34 patients with isolated diagonal branch occlusion (group 9) were compared with those in 20 patients with occlusion at site 6 (group 6) and 20 with occlusion at site 7 (group 7), according to American Heart Association classification. This study had a power > 80% to detect a 50% difference between groups at a probability value of 0.05.
ST segment elevation was observed in leads I and aVL for all group 9 patients, in 80% (p < 0.05) of group 6 patients for lead I and 90% for lead aVL and in 50% (p < 0.01) of group 7 patients for lead I and 55% (p < 0.01) for lead aVL. Similarly, there was a higher incidence of abnormal Q waves and inverted T waves in leads I and aVL in group 9 than in groups 6 and 7. In contrast, group 9 showed a significantly lower incidence of ST segment elevation (3.4%), abnormal Q waves (3.0%) and inverted T waves (0%) in lead V1 than group 6 (80%, 40% and 90%, respectively) and group 7 (75%, 60% and 70%, respectively) (p < 0.01 for each). Multivariate analysis revealed that abnormalities in leads I and aVL, combined with a normal lead V1 (and V6), provided good criteria for distinguishing isolated diagonal branch occlusion from left anterior descending coronary artery occlusion.
Isolated diagonal branch occlusion more frequently caused ECG abnormalities in leads I and aVL and less frequently caused changes in the precordial leads compared with left anterior descending coronary artery obstruction, indicating that leads I and aVL represent myocardium perfused by the diagonal branch.
本研究旨在确定能够区分第一对角支闭塞与左前降支冠状动脉闭塞的心电图（ECG）特征。
先前尚未将与第一对角支阻塞相关的心电图表现与左前降支冠状动脉阻塞的表现进行比较。
根据美国心脏协会分类，将34例孤立对角支闭塞患者（9组）的心电图表现与20例6区闭塞患者（6组）和20例7区闭塞患者（7组）的心电图表现进行比较。本研究在概率值为0.05时检测组间50%差异的功效>80%。
9组所有患者的I导联和aVL导联均观察到ST段抬高，6组患者中80%（p<0.05）的I导联和90%的aVL导联出现ST段抬高，7组患者中50%（p<0.01）的I导联和55%（p<0.01）的aVL导联出现ST段抬高。同样，9组I导联和aVL导联异常Q波和T波倒置的发生率高于6组和7组。相比之下，9组V1导联ST段抬高（3.4%）、异常Q波（3.0%）和T波倒置（0%）的发生率显著低于6组（分别为80%、40%和90%）和7组（分别为75%、60%和70%）（每项p<0.01）。多变量分析显示，I导联和aVL导联异常，同时V1导联（和V6导联）正常，为区分孤立对角支闭塞与左前降支冠状动脉闭塞提供了良好的标准。
与左前降支冠状动脉阻塞相比，孤立对角支闭塞更常导致I导联和aVL导联的心电图异常，而较少导致胸前导联的变化，这表明I导联和aVL导联代表由对角支供血的心肌。
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