Ben-Gal T, Sclarovsky S, Herz I, Strasberg B, Zlotikamien B, Sulkes J, Birnbaum Y, Wagner G S, Sagie A
Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.
J Am Coll Cardiol. 1997 Mar 1;29(3):506-11. doi: 10.1016/s0735-1097(96)00536-0.
This study assessed prospectively the correlation between the conal branch of the right coronary artery and the pattern of ST segment elevation in leads V1 and V3R during anterior wall acute myocardial infarction (AMI).
The traditional electrocardiographic (ECG) definition of anteroseptal AMI-ST segment elevation in leads V1 to V3-has recently been challenged. The significance of ST segment elevation in lead V1 during anterior wall AMI is unclear.
The admission 12-lead ECG with additional lead V3R and the coronary angiograms performed within 10 days of hospital admission were evaluated in 28 consecutive patients (mean age +/- SD 62 +/- 9 years) admitted to the coronary care unit with anterior wall AMI. Patients were classified into two groups according to the magnitude of ST segment elevation in lead V1: group A (elevation > or = 1.5 mm, n = 12) and group B (elevation < 1.5 mm, n = 16). Two types of conal branch were identified: small (not reaching the interventricular septum [IVS]) and large (reaching the IVS).
ST segment elevation in lead V3R was found in 11 (92%) and 6 (37%) patients from group A and group B, respectively (p < 0.001); a small conal branch was seen in 10 (83%) and 3 (19%) patients, respectively (p < 0.001). Ten patients (all from group B) had a large conal branch.
ST segment elevation in lead V1 in the admission ECG of patients with anterior wall AMI is strongly related to ST segment elevation in lead V3R and is associated with a small conal branch. Our findings suggest that lead V1 reflects the right paraseptal area supplied by the septal branches of the left anterior descending coronary artery (LAD), alone or together with the conal branch. The absence of ST segment elevation in lead V1 during anterior AMI suggests that the IVS is protected by a large conal branch in addition to the septal branches of the LAD (double circulation).
本研究前瞻性评估右冠状动脉圆锥支与前壁急性心肌梗死（AMI）时V1和V3R导联ST段抬高模式之间的相关性。
前间壁AMI在V1至V3导联ST段抬高的传统心电图（ECG）定义最近受到挑战。前壁AMI时V1导联ST段抬高的意义尚不清楚。
对28例因前壁AMI入住冠心病监护病房的连续患者（平均年龄±标准差62±9岁）入院时的12导联ECG加V3R导联以及入院10天内进行的冠状动脉造影进行评估。根据V1导联ST段抬高幅度将患者分为两组：A组（抬高≥1.5mm，n = 12）和B组（抬高<1.5mm，n = 16）。识别出两种类型的圆锥支：小圆锥支（未到达室间隔[IVS]）和大圆锥支（到达IVS）。
A组和B组分别有11例（92%）和6例（37%）患者出现V3R导联ST段抬高（p<0.001）；分别有10例（83%）和3例（19%）患者出现小圆锥支（p<0.001）。10例患者（均来自B组）有大圆锥支。
前壁AMI患者入院ECG的V1导联ST段抬高与V3R导联ST段抬高密切相关，且与小圆锥支有关。我们的研究结果表明，V1导联反映了由左前降支冠状动脉（LAD）间隔支单独或与圆锥支共同供应的右间隔旁区域。前壁AMI时V1导联无ST段抬高提示除LAD间隔支外，IVS还受到大圆锥支的保护（双重循环）。
