de Chillou C, Doevendans P, Cheriex E, Rodriguez L M, Metzger J, Pieters F, Smeets J L, Wellens H J
Department of Cardiology, University of Limburg Academic Hospital, Maastricht, The Netherlands.
Eur Heart J. 1993 Jun;14(6):795-8. doi: 10.1093/eurheartj/14.6.795.
We studied the relationship between wall motion abnormalities determined by echocardiography and the signal-averaged electrocardiogram in 82 consecutive patients during the acute phase of a first myocardial infarction. An abnormal signal-averaged electrocardiogram was defined as the presence of two of the following criteria: a QRS duration > or = 114 ms, a root mean square voltage (RMS) of the last 40 ms < or = 25 microV and an amplitude signal lower than 40 microV lasting > or = 39 ms. The left ventricle was divided into 13 segments and the contraction pattern divided into akinesia alone (including dyskinesia) (group A), hypokinesia alone (group B) and both hypokinesia and akinesia (group C). An abnormal signal-averaged electrocardiogram was found in 14/82 patients (17%) and was correlated with the persistence of occlusion of the infarct-related vessel (32% vs 9%, P < 0.02). In patients with a patent vessel, the incidence of an abnormal signal-averaged electrocardiogram was 14% in group A, 9% in group B and 0% in group C (NS). In patients with an occluded vessel an abnormal signal-averaged electrocardiogram was found in 10% of group A patients, in 36% in group B patients and in 75% of group C patients (P = 0.05). Our study suggests that the presence of hypokinetic areas during the acute phase of a first myocardial infarction and an abnormal signal-averaged electrocardiogram indicate an occluded infarct-related vessel.
我们研究了82例首次心肌梗死急性期连续患者经超声心动图测定的室壁运动异常与信号平均心电图之间的关系。异常信号平均心电图定义为存在以下两项标准：QRS时限≥114毫秒、最后40毫秒的均方根电压（RMS）≤25微伏以及持续时间≥39毫秒的低于40微伏的振幅信号。左心室被分为13个节段，收缩模式分为单纯运动不能（包括运动障碍）（A组）、单纯运动减弱（B组）以及运动减弱和运动不能并存（C组）。在82例患者中有14例（17%）发现异常信号平均心电图，且其与梗死相关血管持续闭塞相关（32%对9%，P<0.02）。在血管通畅的患者中，A组异常信号平均心电图的发生率为14%，B组为9%，C组为0%（无显著性差异）。在血管闭塞的患者中，A组患者中有10%发现异常信号平均心电图，B组患者中有36%，C组患者中有75%（P=0.05）。我们的研究表明，首次心肌梗死急性期存在运动减弱区域以及异常信号平均心电图提示梗死相关血管闭塞。
