aVR、V_1导联心电图对左主干及前降支近端明显狭窄的诊断价值  

The value of aVR and V_1 leads in the diagnoses of severely narrowed left main and proximal left anterior descending coronary artery

作　　者：王龙[1] 郭继鸿[1] 王伟民[1] 朱天刚[1] 

机构地区：[1]北京大学人民医院,100044

出　　处：《临床心电学杂志》2007年第2期93-96,共4页Journal of Clinical Electrocardiology

基　　金：国家自然科学基金资助(项目批准号:30670846

摘　　要：目的探讨aVR、V1导联对冠状动脉左主干及前降支近端狭窄诊断的阳性预测价值。方法对比分析120例冠造结果为左主干病变患者典型aVR、V1导联心电图改变的几率,对比分析120例心电图有典型变化患者的冠脉造影结果。结果①有68例(占56.7%,68/120,)的左主干病变患者出现了典型的aVR、V1导联心电图表现,即典型“左主干”心电图对左主干病变诊断的敏感性为56.7%;②有31例(占37.3%,31/83)典型aVR、V1导联心电图患者冠造结果为左主干病变,有81例(占97.6%,81/83)的典型aVR、V1导联心电图患者冠造结果为左主干及前降支病变,37例患者未检查冠造,典型“左主干”心电图对左主干病变的阳性预测价值为37.3%,而对左主干及/或前降支近段狭窄病变的预测价值为97.6%,二者的差异有显著性(p<0.001)。结论心电图出现aVR、V1导联ST抬高>1mm,且aVR导联ST段抬高>V1导联,V4-6导联ST段下移≥2mm,II、III、aVF导联ST段下移≥1mm对诊断左主干或前降支近段明显狭窄有很好的阳性预测价值。Objective To investigate the value of aVR and V, leads in the diagnoses of severely narrowed left main and proximal left anterior descending coronary artery. Methods The ECGs of 120 patients with severely narrowed left main coronary artery in coronary angiographic findings were analyzed to find the number of patients with ＂typical＂ ECG. 120 patients with ＂typical＂ ECG （including 12 lead ECG, Holter, Treadmill exercise tests） were studied on their medical records to search their coronary angiographic findings. Result （1） 68（56.7%, 68/120） patients with severely narrowed left main coronary artery in coronary angiographic findings were of ＂typ- ical＂ ECG. 31 （37.3%, 31/83） patients with ＂typical＂ ECG showed severely narrowed left main coronary artery in coronary angiographic findings. 81 （97.6%,81/83） patients with ＂typical＂ ECG showed in their coronary angiographic findings as severely narrowed left main and/or proximal left anterior descending coronary artery. Conclusion ＂Typical＂ ECG including ST segment elevations in lead aVR and V1 （STaVR〉STV1） as well as ST segment depressions in V4 through V6 and Ⅱ. Ⅲ and aVF, are good indicators in predictive severely narrowed left main and/ or proximal left anterior descending coronary artery.

关 键 词：AVR V1导联 左主干 前降支近端 

分 类 号：R541.4[医药卫生—心血管疾病]