摘要
目的:分析急性冠状动脉左主干(LM)闭塞的常规心电图(ECG)表现,总结其ECG特点。方法:15例急性心肌梗死(AMI)患者经冠状动脉造影证实为急性LM闭塞(LM组),回顾性分析其急诊ECG表现。并选取同时期30例左前降支(LAD)近段闭塞的AMI患者(LAD组),比较2组造影前的急诊ECG表现,以求总结急性LM闭塞的常规ECG特点。结果:LM组心率快于LAD组,心律失常发生率2组差异无统计学意义。LM组中13例患者存在aVR导联ST段抬高(≥0.05mV),发生率明显高于LAD组(分别为86.7%和36.7%,P<0.01),同时LM组aVR导联ST段抬高幅度亦明显大于LAD组。而LM组胸前导联V1～3的ST段抬高程度则明显低于LAD组。aVR导联ST段抬高>0.05mV诊断急性LM闭塞的敏感性为90%,特异性为63.3%。如果同时再满足V1～3导联ST段抬高程度<0.5mV,其诊断急性LM闭塞的敏感性为90%,特异性达到86.7%。结论:aVR导联ST段抬高≥0.05mV,同时伴有V1～3导联ST段抬高不明显、甚至压低是急性LM闭塞区别于LAD闭塞的ECG特点,结合临床表现,分析ECG特点可能有助于造影前预测此类患者和进行风险评价。
Objective： The electrocardiograms in patients with AMI associated with left main（LM）artery obstruction were analyzed retrospectively to determine the electrocardiographic features in this group of patients. Method：From Jan 1999 to June 2007 ,acute LM obstruction were confirmed in 15 patients with AMI by emergency coronary angiography. The emergency electrocardiograms before angiography in these 15 patients（LM group）were analyzed retrospectively, and their electrocardiographic features were compared with those in 30 patients with AMI resulted from proximal left anterior descending artery obstruction （ LAD group ） . Result ： There was no significant difference in occurrence of arrhythmia between the two groups. Heart rate in the LM group was higher than that in the LAD group. The occurrence rate and degree of ST segment elevation in lead aVR were both significantly higher in the LM group compared with the LAD group. The degree of ST segment elevation in lead V1 , V2 and V3 were also lower in the LM group compared with the LAD group. ST elevation in aVR predicted LM obstruction with sensitivity of 90 % and specificity of 63.3 %. Both ST elevation in aVR （〉0.05 mV） and minor ST elevation in V1-3 （total level 〈0- 5 mV） represented left main obstruction with sensitivity of 90% and specificity of 86.7%. Conclusion： ST elevation in aVR with minor ST elevation in V1-3 is an important predictor of acute left main artery obstruction.
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2008年第2期111-113,共3页
Journal of Clinical Cardiology
关键词
心肌梗死
冠状动脉狭窄
心电描记术
Myocardial infarction
Coronary stenosis
Electrocardiography
