心电图“6+2”现象对左主干病变诊断价值的再探讨  

Re-discussion on the diagnostic value of the "6+2" phenomenon of electrocardiogram for left main coronary artery stenosis

作　　者：冯应君[1] 刘纯钢[1] 王婷[1] 叶培机 聂文娟 谭景[1] 黄艳 Feng yingjun;Liu chungang;Wang ting;Ye peiji;Nie wenjuan;Tan jing;Huang yan(Yuebei people’s Hospital,Shaoguan,512026,China)

机构地区：[1]广东省韶关市粤北人民医院,512026

出　　处：《临床心电学杂志》2021年第4期250-253,共4页Journal of Clinical Electrocardiology

摘　　要：目的了解心电图"6+2"现象对左主干病变或三支病变的诊断价值及其影响因素。方法回顾性分析72例心电图符合"6+2"现象、同期进行了冠状动脉造影的患者12导联同步心电图、超声心动图、冠状动脉造影结果,按照冠脉病变支数分为0-1支病变组、2支病变组、3支病变组、左主干病变组,分析心电图"6+2"现象对左主干病变及3支病变的诊断价值,心肌肥厚对诊断价值的影响,以及各导联ST段改变的幅度。结果共72例患者,其中0-1支病变16例,2支病变12例、3支病变30例、左主干病变14例,超声心动图显示心肌肥厚的占比依次为56.25%、58.33%、23.33%、21.43%(p<0.05);心电图"6+2"现象诊断左主干或3支病变的阳性预测值为61.11%,去除心肌肥厚因素后阳性预测值为73.91%,在心肌肥厚患者中阳性预测值为38.46%(p<0.01);左主干病变患者在V_(2)-V_(3)、V_(4)-V_(6)导联ST段下移较其他组更为显著(p<0.01),3支病变患者V_(2)-V_(3)导联ST段下移较2支病变患者更为显著(p<0.05)。结论心电图"6+2"现象对左主干病变或三支病变有较高的诊断价值,但是心肌肥厚是重要的干扰因素,胸导联ST段下移幅度越大对左主干病变的预测价值越高。Objective Toinvestigate the diagnostic value and influencingfactors ofthe "6+2" phenomenon ofthe ECG on left main coronary artery stenosis or three-vessel disease. Methods The 12-lead synchronized ECG,echocardiography, and coronary angiography results of 72 patients whose ECG conformed to the "6+2" phenomenon and who underwent coronary angiography at the same time were analyzed retrospectively. According to the number of coronary artery lesions, they were divided into 0-1 lesions disease Group, 2-vessel disease group, 3-vessel disease group, left main disease group.The diagnostic value of the ECG "6+2" phenomenon on the left main disease and three-vessel disease, the influence of myocardial hypertrophy on the diagnostic value, and the Amplitude of ST segment changes in each lead were analyzed. Results Among the 72 patients, there were 16 cases of 0-1 vessel lesion group, 12 cases of 2-vessel lesion group, 30 cases of 3-vessel lesion group, and 14 cases of left main vessel lesion group. The ratio of cardiac hypertrophy showed by echocardiography(p<0.05) was 56.25%, 58.33%, 23.33%, 21.43%, respectively. The positive predictive value of ECG "6+2" phenomenon in the diagnosis of left main or 3-branch lesions was 61.11%,73.91% after removal of myocardial hypertrophy factors,38.46% in patients with myocardial hypertrophy(p<0.01);The ST segment depression of V;-V;leads and V;-V;leads in the patients with left main vessel lesion was more significantly increased than that in the other groups(p<0.01), and the ST segment Depression of V;-V;leads in the patients with 3-vessel lesion group was more significantly increased than that in the patients with 2-vessel lesion group(p<0.05).Conclusions The "6+2" phenomenon of ECG has a high diagnostic value for left main coronary artery stenosis or three-vessel disease, but myocardial hypertrophy is an important interfering factor. The greater the ST depressing Amplitude of chest lead is, the higher the predictive value for left main lesions is.

关 键 词：心电图 冠状动脉造影 超声心动图 左主干病变 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]