急性心肌梗死ST_(aVR)>ST_(V1)对重度左主干病变的诊断价值  

ST_(aVR)>ST_(V1) on electrocardiography in diagnosis of severe left main coronary artery disease

作　　者：刘元伟[1] 钟诚[1] 孙国建[1] 王亚利[1] 何浪[1] 沈法荣[1] 

机构地区：[1]浙江医院心内科,杭州310013

出　　处：《浙江医学》2013年第11期991-993,共3页Zhejiang Medical Journal

摘　　要：目的探讨体表心电图aVR和V_1ST段相对抬高程度对左主干病变引起的急性心肌梗死的诊断价值。方法回顾性分析因急性心肌梗死住院而行冠状动脉造影的29例患者的心电图,按左主干病变程度分为两组,严重病变(狭窄≥70%狭窄)组(18例);普通病变(狭窄<70%)组(11例)。通过分析心电图aVR和V_1ST段抬高程度与左主干病变的关系,计算以心电图出现ST_(aVR)>ST_(V1)预测重度左主干狭窄引起急性心肌梗死的敏感性、特异性、阳性预测值及阴性预测值。结果 18例冠状动脉造影诊断重度左主干病变组患者中有7例心电图呈ST_(aVR)>ST_(V1),其中1例为孤立性左主干病变,诊断敏感性为38.9%;普通病变组中1例前降支合并回旋支狭窄心电图呈ST_(aVR)>ST_(V1),诊断特异性为90.9%,阳性预测值87.5%,阴性预测值47.6%。结论 ST_(aVR)>ST_(V1)Ⅵ诊断左主干病变特异性较高,但敏感性较差,该心电图征象有助于识别急性冠状动脉综合征中的高危患者。Objective To evaluate STaVR〉STv1 on electrocardiography （ECG） in diagnosis of severe left main coronary artery disease. Methods The ECG findings and clinical data of 29 patients with acute myocardial infarction（AMI） induced by left main coronary artery stenosis （LMCA） were retrospectively reviewed. The patients were allocated to two groups： severe LMCA （stenosis ≥70%, n=18） and moderate LMCA （stenosis〈70%, n= 11）. The association of ST elevation on lead aVR and V1 with the severity of LMCA was analyzed. Results In the severe LMCA group, there were 7 cases showing the sign of STaVR〉STv1, includ- ing one case with an isolated LMCA disease. The sensitivity of STaVR〉STv1 in diagnosis of severe LMCA was 38.9%. In the moder- ate LMCA group, one patients with stenosis on left anterior descending （LAD） and circumflex branches presented ECG STaVR〉STv1. The specificity, positive predictive value and negative predictive value of ECG STaVR〉STv1 in diagnosis of severe LMCA were 90.9%, 87.5% and 47.6%, respectively. Conclusion ECG STaVR〉STv1 is a specific indicator for severe LMCA, which can be of value in recognition of high risk patients in acute coronary syndrome.

关 键 词：急性心肌梗死 左主干 心电图 

分 类 号：R542.22[医药卫生—心血管疾病]