心电图R波递增不良诊断前壁心肌梗死756例分析  

The value of electrocardiographic poor R-wave progression in diagnosing anterior myocardial infarction : analysis of 756 cases

作　　者：曾学寨[1] 刘德平[1] 何青[1] 姚稚明[2] 张建飞[2] 张闻多[1] 陈培亮 董榕[1] 曾环宇[1] 

机构地区：[1]卫生部北京医院心内科,100730 [2]卫生部北京医院核医学科,100730 [3]湖南浏阳市中医院老干部科

出　　处：《中国心血管杂志》2010年第1期20-23,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨心电图R波递增不良（PRWP）诊断前壁心肌梗死（MI）的价值。方法回顾性分析2000--2006年本院核医学科连续进行的三磷酸腺苷（ATP）负荷心肌核素灌注断层显像（MPI）检查病例的心电图，排除前壁Q波MI或前壁导联异常q波、束支阻滞、预激综合征、心室肥厚、心房颤动、心室起搏心电图、MPI图像质量差的病例及MPI诊断为基底部下壁MI的病例，应用心电图PRWP的常规诊断标准Marquette、Zema、Warner和Depace以及10种新的诊断标准对药物负荷MPI检查前卧位标准12导联心电图进行分析，将多个标准诊断的心电图PRWP同药物负荷MPI前壁MI检出结果进行比较。结果符合入选标准的病例756例，常规标准心电图PRWP的检出率为2．0％～18．0％，MPI检出前壁MI43例中，常规标准心电图PRWP检出率为14．0％～48．8％，常规标准心电图PRWP病例中前壁MI检出率为15．4％～40．0％。常规及新诊断标准中的A、B、C、D、E、H、I、J标准诊断的心电图PRWP阳性组前壁MI检出率显著高于心电图PRWP阴性组，但上述标准的正确诊断指数（Youden指数）为0．11～0．51。结论心电图PRWP诊断前壁MI价值有限。Objective Poor R-wave progression （PRWP） is a common technical term in electrocardiographic interpretation, but its value in the diagnosis of anterior myocardial infarction （MI） is disputed. The value of electrocardiographic PRWP in the diagnosis of anterior MI was assessed in this study. Methods The resting electrocardiograms （ECGs） of consecutive patients undergoing single photon emission computed tomography with adenosine triphosphate stress test from 2000 to 2006 in Beijing Hospital were analyzed retrospectively. Subjects with Q-wave anterior MI, q-wave in the right precordial leads, bundle branch block, Wolf-Parkinson-White syndrome, atrial fibrillation, ventricular hypertrophy, poor image quality or posterior MI diagnosed by myocardial perfusion imaging were excluded. Four standard PRWP criteria namely Marquette, Zema, Warner and Depace as well as 10 novel criteria from A to J were used to analyze the ECGs. It was noted whether the patients met the PRWP criteria or not.x^2 method was used for comparing the electrocardiographic and seintigraphic diagnosis in these subjects. Results A total of 756 subjects met the inclusion criteria, 43 subjects had scintigraphie anterior MI. The standard PRWP criteria were met in 2.0% to 18.0% of ECGs. Of the subjects meeting the standard PRWP criteria, 15.4% to 40. 0% had scintigraphic anterior MI. Of the subjects with scintigraphic anterior MI, 14. 0% to 48.8% met the standard PRWP criteria. The standard PRWP criteria and 8 of the 10 novel PRWP criteria A, B, C, D, E, H, I and J showed significant differences in the prevalence of anterior MI between the PRWP group and control group, but the sensitivity and positive predictive value of these criteria were low, the Youden index was 0. 11 - 0. 51. Conclusions The value of electrocardiographic poor R-wave progression in diagnosing anterior myocardial infarction is limited.

关 键 词：心电描记术 心肌梗死 三磷酸腺苷 

分 类 号：R542.22[医药卫生—心血管疾病] R540.41[医药卫生—内科学]