首次急性前壁心肌梗死患者心电图模式与TIMI血流分级及射血分数之间的关系。

The relationship between the electrocardiographic pattern with TIMI flow class and ejection fraction in patients with a first acute anterior wall myocardial infarction.

作者信息

Kusniec J, Solodky A, Strasberg B, Klainmann E, Herz I, Zlotikamien B, Sclarovsky S

机构信息

Department of Cardiology, Rabin Medical Center, Petah Tiqva, Israel.

出版信息

Eur Heart J. 1997 Mar;18(3):420-5. doi: 10.1093/oxfordjournals.eurheartj.a015261.

DOI:10.1093/oxfordjournals.eurheartj.a015261

PMID:9076378

Abstract

AIMS

The aim of this study was to assess the value of the electrocardiogram in predicting the patency of the left anterior descending artery and left ventricular ejection fraction in patients with a first acute anterior wall myocardial infarction at discharge from the coronary care unit.

METHOD

We included 116 consecutive patients with an acute anterior myocardial infarction who had undergone coronary angiography and left ventriculography before discharge from the coronary care unit (7th to 10th day). The ST segment, either elevated or isoelectric (< 1 mm), and the T wave (positive or negative) in precordial leads V2-V4 were analysed and compared to the TIMI flow from each patient.

RESULTS

Out of 69 patients with negative T waves, 38 (55%) had TIMI flow 3 compared with 20 (29%) and 11 (16%) with TIMI flow 2 and 0-1, respectively; and out of 47 patients with positive T waves seven (15%) had TIMI flow 3, 17 (36%) TIMI flow 2 and 23 (49%) TIMI flow 0-1 (P < 0.001). Out of 63 patients with an isoelectric ST segment, 35 (55%) had TIMI flow 3, 18 (29%) TIMI flow 2 and 10 (16%) TIMI flow 0-1, and out of 53 with ST segment elevation, 10 (19%) had TIMI flow 3, 19 (36%) TIMI flow 2 and 24 (45%) TIMI flow 0-1 (P < 0.001). When both parameters were analysed together, we found that in 46 patients with both isoelectric ST segments and negative T waves, 30 (65%) had TIMI flow 3 compared with two of 30 (7%) patients with ST segment elevation and positive T waves (P < 0.001). Patients with isoelectric ST segments had a better degree of left ventricular ejection fraction (57.8 +/- 14.1%) than patients with ST segment elevation (41.7 +/- 13%) (P < 0.001). Patients with positive and negative T waves had a similar left ventricular ejection fraction (49 +/- 18.1% vs 51 +/- 14%).

CONCLUSION

We concluded that patients with a first acute anterior myocardial infarction and an electrocardiogram pattern of an isoelectric ST segment and a negative T wave have a higher incidence of a patent left anterior descending coronary artery than similar patients with ST segment elevation and a positive T wave. An isoelectric ST segment is also related to better left ventricular function.

摘要

目的

本研究旨在评估心电图对首次急性前壁心肌梗死患者在冠心病监护病房出院时左前降支通畅情况及左心室射血分数的预测价值。

方法

我们纳入了116例连续的急性前壁心肌梗死患者，这些患者在冠心病监护病房出院前（第7至10天）接受了冠状动脉造影和左心室造影。分析胸前导联V2-V4的ST段（抬高或等电位线<1mm）和T波（正向或负向），并与每位患者的TIMI血流进行比较。

结果

在69例T波阴性的患者中，38例（55%）TIMI血流为3级，相比之下，TIMI血流为2级的有20例（29%），TIMI血流为0-1级的有11例（16%）；在47例T波阳性的患者中，7例（15%）TIMI血流为3级，17例（36%）TIMI血流为2级，23例（49%）TIMI血流为0-1级（P<0.001）。在63例ST段等电位线的患者中，35例（55%）TIMI血流为3级，18例（29%）TIMI血流为2级，10例（16%）TIMI血流为0-1级，在53例ST段抬高的患者中，10例（19%）TIMI血流为3级，19例（36%）TIMI血流为2级，24例（45%）TIMI血流为0-1级（P<0.001）。当对两个参数一起分析时，我们发现，在46例ST段等电位线且T波阴性的患者中，30例（65%）TIMI血流为3级，相比之下，30例ST段抬高且T波阳性的患者中有2例（7%）TIMI血流为3级（P<0.001）。ST段等电位线的患者左心室射血分数程度（57.8±14.1%）优于ST段抬高的患者（41.7±13%）（P<0.001）。T波正向和负向的患者左心室射血分数相似（49±18.1%对51±14%）。