急性前壁心肌梗死时的短暂性巨大负向T波可预测R波恢复及左心室功能的保留。
Transient giant negative T wave in acute anterior myocardial infarction predicts R wave recovery and preservation of left ventricular function.
作者信息
Agetsuma H, Hirai M, Hirayama H, Suzuki A, Takanaka C, Yabe S, Inagaki H, Takatsu F, Hayashi H, Saito H
机构信息
First Department of Internal Medicine, University of Nagoya School of Medicine, Japan.
出版信息
Heart. 1996 Mar;75(3):229-34. doi: 10.1136/hrt.75.3.229.
OBJECTIVE
To investigate the value of a giant negative T wave (> or = 1.0 mV) in precordial leads of 12-lead electrocardiograms in the acute phase of Q wave myocardial infarction as a predictor of myocardial salvage.
METHODS
Coronary angiographic and electrocardiographic findings, left ventricular ejection fraction in the chronic stage, and levels of cardiac enzymes were compared in patients with myocardial infarction with (group GNT, n = 31) and without (group N, n = 20) a giant negative T wave. GNT patients were divided into two subgroups according to the presence (GNT:R[+], n = 10) or absence (GNT: R[-], n = 21) of R wave recovery with an amplitude > or = 0.1 mV in at least one lead that had shown Q waves.
RESULTS
The maximum level of creatine kinase and the total creatine kinase were lower in group GNT compared with group N (P < 0.05). The left ventricular ejection fraction was higher in group GNT than in group N (P < 0.05). The maximum creatine kinase and total creatine kinase were lower in GNT:R(+) than in GNT:R(-) (P < 0.01). The left ventricular ejection fraction was higher in GNT:R(+) than in GNT:R(-) (P < 0.01). The frequency of R wave recovery was significantly higher when giant negative T waves appeared within 100 h of myocardial infarction or when the maximum potential was > or = 1.4 mV. The appearance of a giant negative T wave > or = 1.4 mV had a sensitivity of 90%, a specificity of 71.4%, a diagnostic accuracy of 77.4%, a positive predictive value of 60%, and a negative predictive value of 93.8% for prediction of R wave recovery.
CONCLUSIONS
The appearance of a giant negative T wave, especially within 100 h of the onset of myocardial infarction, with a maximum potential of > or = 1.4 mV, may predict a reappearance of the R wave and a better left ventricular function in patients in the chronic stage of anterior myocardial infarction.
目的
探讨12导联心电图胸前导联巨大负向T波（≥1.0mV）在Q波心肌梗死急性期作为心肌挽救预测指标的价值。
方法
比较有（GNT组，n = 31）和无（N组，n = 20）巨大负向T波的心肌梗死患者的冠状动脉造影和心电图表现、慢性期左心室射血分数以及心肌酶水平。GNT组患者根据至少一个曾出现Q波的导联中R波恢复情况（振幅≥0.1mV）分为两个亚组，即有R波恢复（GNT:R[+]，n = 10）和无R波恢复（GNT:R[-]，n = 21）。
结果
GNT组的肌酸激酶峰值和总肌酸激酶水平低于N组（P < 0.05）。GNT组的左心室射血分数高于N组（P < 0.05）。GNT:R(+)组的肌酸激酶峰值和总肌酸激酶低于GNT:R(-)组（P < 0.01）。GNT:R(+)组的左心室射血分数高于GNT:R(-)组（P < 0.01）。当巨大负向T波在心肌梗死100小时内出现或最大电位≥1.4mV时，R波恢复频率显著更高。≥1.4mV的巨大负向T波出现对R波恢复预测的敏感度为90%，特异度为71.4%，诊断准确率为77.4%，阳性预测值为60%，阴性预测值为93.8%。
结论
巨大负向T波的出现，尤其是在心肌梗死发病100小时内且最大电位≥1.4mV时，可能预示前壁心肌梗死慢性期患者R波重现及左心室功能改善。
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