急性前壁心肌梗死时Ⅲ导联ST段压低伴T波方向的价值：“包绕型”左前降支的心电图预测

Value of T-wave direction with lead III ST-segment depression in acute anterior wall myocardial infarction: electrocardiographic prediction of a "wrapped" left anterior descending artery.

作者信息

Porter A, Sclarovsky S, Ben-Gal T, Herz I, Solodky A, Sagie A

机构信息

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

出版信息

Clin Cardiol. 1998 Aug;21(8):562-6. doi: 10.1002/clc.4960210806.

DOI:10.1002/clc.4960210806

PMID:9702382

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6656065/

Abstract

BACKGROUND

Lead III ST-segment depression during acute anterior wall myocardial infarction (AMI) has been attributed to reciprocal changes. However, the value of the T-wave direction (positive or negative) in predicting the site of obstruction and type of the left anterior descending (LAD) artery is not clear and has not been studied before.

HYPOTHESIS

The aim of the study was to assess retrospectively the correlation between two patterns of lead III ST-segment depression, and type of LAD artery and its level of obstruction during first AMI.

METHODS

The study group consisted of 48 consecutive patients, admitted to the coronary care unit for first AMI, who showed ST-segment elevation in lead a VL and ST-segment depression in lead III on admission 12-lead electrocardiogram. The patients were divided by T-wave direction into Group 1 (n = 31), negative T wave, and Group 2 (n = 17), positive T wave. The coronary angiogram was evaluated for type of LAD ("wrapped", i.e., surrounding the apex or not), site of obstruction (pre- or postdiagonal branch), and other significant coronary artery obstructions.

RESULTS

Mean lead III ST-segment depression was 1.99 +/- 1.32 mm in Group 1 and 1.13 +/- 0.74 mm in Group 2 (p = 0.004); mean ST-segment elevation in a VL was 1.35 +/- 0.84 mm and 1.23 +/- 0.5 mm, respectively (p = 0.5). A wrapped LAD was found in 12 patients (38.7%) in Group 1 and in 13 in Group 2 (76.4%) (p = 0.02). The sensitivity of lead III ST-segment depression with positive T wave to predict a wrapped LAD was 52%, and the specificity was 82% with a positive predictive value of 76%. On angiography, 25 patients (80%) in Group 1 and 13 (76%) in Group 2 had prediagonal occlusion of the LAD (p = 0.77). No significant difference between groups was found for right and circumflex coronary artery involvement or incidence of multivessel disease.

CONCLUSIONS

The presence of lead III ST-segment depression with positive T wave associated with ST-segment elevation in a VL in the early course of AMI can serve as an early electrocardiographic marker of prediagonal occlusion of a "wrapped" LAD.

摘要

背景

急性前壁心肌梗死（AMI）期间Ⅲ导联ST段压低一直被认为是对应性改变。然而，T波方向（正向或负向）在预测左前降支（LAD）动脉阻塞部位和类型方面的价值尚不清楚，且此前未被研究过。

假设

本研究的目的是回顾性评估首次AMI期间Ⅲ导联ST段压低的两种模式与LAD动脉类型及其阻塞程度之间的相关性。

方法

研究组由48例因首次AMI入住冠心病监护病房的连续患者组成，他们入院时12导联心电图显示aVL导联ST段抬高，Ⅲ导联ST段压低。根据T波方向将患者分为第1组（n = 31），T波负向，和第2组（n = 17），T波正向。对冠状动脉造影评估LAD类型（“包绕型”，即是否环绕心尖）、阻塞部位（对角支之前或之后）以及其他显著的冠状动脉阻塞情况。

结果

第1组Ⅲ导联ST段平均压低为1.99±1.32mm，第2组为1.13±0.74mm（p = 0.004）；aVL导联ST段平均抬高分别为1.35±0.84mm和1.23±0.5mm（p = 0.5）。第1组12例患者（38.7%）发现LAD为包绕型，第2组13例（76.4%）（p = 0.02）。Ⅲ导联ST段压低伴T波正向预测包绕型LAD的敏感性为52%，特异性为82%，阳性预测值为76%。血管造影显示，第1组25例患者（80%）和第2组13例患者（76%）LAD在对角支之前闭塞（p = 0.77）。两组在右冠状动脉和回旋支受累情况或多支血管病变发生率方面未发现显著差异。