Shiran A, Halon D A, Merdler A, Makhoul N, Khader N, Ben-David J, Lewis B S
Department of Cardiology, Lady Davis Carmel Medical Center, Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa.
Cardiology. 1998 May;89(4):297-302. doi: 10.1159/000006802.
In this prospective study, we examined the diagnostic accuracy of exercise-induced left QRS axis deviation as a marker of LAD coronary artery stenosis. The mean frontal QRS axis of 66 consecutive patients with chest pain and exercise-induced ST segment depression referred for diagnostic coronary angiography was analyzed and related to the angiographic findings. An exercise-induced leftward QRS axis deviation was found in 9/40 patients with and 0/26 patients without obstructive (> or = 70%) LAD disease (sensitivity 23%, specificity 100%, p = 0.025). In 7 of the 9 patients with left axis deviation, the lesion was proximal to and in 2 in the region of the first septal perforator. Inclusion of patients with 0 degrees exercise-induced QRS axis deviation provided a more sensitive but less specific marker of LAD disease [sensitivity 53% (21/40), specificity 81% (21/26), p = 0.015]. The findings were similar in patients with single and with multivessel coronary artery disease. Grouping all patients in the present prospective and two previous retrospective studies (n = 165), the sensitivity was 29% and specificity 100% (p < 0.0001). Exercise-induced left QRS axis deviation was a highly specific marker of LAD coronary artery stenosis.
在这项前瞻性研究中，我们检测了运动诱发的左QRS轴偏移作为左前降支（LAD）冠状动脉狭窄标志物的诊断准确性。对66例因胸痛和运动诱发ST段压低而接受诊断性冠状动脉造影的连续患者的平均额面QRS轴进行了分析，并将其与血管造影结果相关联。在40例有LAD阻塞性（≥70%）病变的患者中，9例出现运动诱发的左QRS轴偏移，而在26例无LAD阻塞性病变的患者中，0例出现运动诱发的左QRS轴偏移（敏感性23%，特异性100%，p = 0.025）。在9例出现左轴偏移的患者中，7例病变位于第一间隔支穿支近端，2例位于第一间隔支穿支区域。纳入运动诱发QRS轴偏移为0度的患者，可提供一个对LAD病变更敏感但特异性较低的标志物[敏感性53%（21/40），特异性81%（21/26），p = 0.015]。单支冠状动脉疾病患者和多支冠状动脉疾病患者的结果相似。将本前瞻性研究以及之前两项回顾性研究中的所有患者（n = 165）进行分组分析，敏感性为29%，特异性为100%（p < 0.0001）。运动诱发的左QRS轴偏移是LAD冠状动脉狭窄的一个高度特异性标志物。
