应用额面ST段向量判断I-STEMI冠脉节段病变  

Clinical significance of frontal ST segment vector for identifying coronary segmental lesions in I-STEMI

作　　者：郭其凤 匡德俊 唐弘玉 许祥林 韩旭 李文涛 GUO Qi-feng;KUANG De-jun;TANG Hong-yu;XU Xiang-lin;HAN Xu;LI Wen-tao(Department of Internal Medicine-Cardiovascular,the Affiliated Hospital of Zunyi Medical University,Zunyi,Guizhou 563000,China;Department of Internal Medicine-Cardiovascular,the Second Affiliated Hospital of Zunyi Medical University,Zunyi,Guizhou 563000,China;Contec Medical Systems,Qinhuangdao,Hebei 066004,China)

机构地区：[1]遵义医科大学附属医院心血管内科,贵州遵义563000 [2]遵义医科大学第二附属医院心血管内科,贵州遵义563000 [3]秦皇岛康泰医学有限公司,河北秦皇岛066004

出　　处：《医药论坛杂志》2024年第16期1721-1726,共6页Journal of Medical Forum

摘　　要：目的探讨应用ST段额面向量(ST-segment frontal vector,ST-VF)判断ST抬高型下壁心肌梗死(inferior ST-elevation myocardial infarctions,I-STEMI)冠脉病变血管的临床价值。方法回顾性分析近10余年来遵义医科大学附属医院及遵义医科大学第二附属医院收治并经冠脉造影证实为单支冠脉病变的I-STEMI患者,采用自主研发的计算机软件对12导联数字心电信号进行自动测量并辅以人工校正,计算ST-VF及ST电轴(ST-A_(F)),分析ST_(Ⅱ)与ST_(Ⅲ)抬高程度、ST-VF大小、ST-A_(F)在不同冠脉节段病变间的差异。结果572例I-STEMI中右冠脉(RCA)病变417例(72.90%),左回旋支(LCX)病变114例(19.93%),左前降支(LAD)病变41例(7.17%)。ST_(Ⅱ)与ST_(Ⅲ)抬高程度、ST-VF大小在各冠脉不同节段病变间无显著性差异(P>0.05)。ST-A_(F)以及ST_(Ⅱ)/ST_(Ⅲ)值在各冠脉不同节段病变间有显著性差异,ST-A_(F)与ST_(Ⅱ)/ST_(Ⅲ)值在数学上可以完全互换。ROC曲线分析表明RCA近中段病变截断值≥114°(AUC:0.96,95%CI:0.95~0.98);LCX近段病变截断值≤94.46°(AUC:1.0,95%CI:1.0);LAD中远段病变与RCA远段、LCX远段病变不能有效区分差异无统计学意义(P>0.05)。结论ST-A_(F)(或ST_(Ⅱ)/ST_(Ⅲ)值)可以有效判别RCA近中段病变和LCX近段病变,但不能有效判断LAD中远段、RCA远段以及LCX远段病变。Objective To investigate the clinical value of using ST-segment vector(ST-VF)analysis in determining the coronary artery involvement in inferior wall ST-elevation myocardial infarction(I-STEMI).Methods This study conducted a retrospective analysis of I-STEMI cases over the past decade across the Affiliated Hospital of Zunyi Medical University and the Second Affiliated Hospital of Zunyi Medical University with confirmed single-vessel coronary artery lesions through coronary angiography.Computer software,self-developed,was employed for the automatic measurement of 12-lead digital electrocardiogram(ECG)signals,which were subsequently manually corrected.ST-VF and ST electrical axis(ST-A_(F))were calculated.This study compared the degree of ST-segment elevation in leadsⅡandⅢ,the magnitude of ST-VF,and the ST-A_(F)among different coronary artery segment lesions.Results Among 572 cases of I-STEMI,417(72.90%)had right coronary artery(RCA)lesions,114(19.93%)had left circumflex artery(LCX)lesions,and 41(7.17%)had left anterior descending artery(LAD)lesions.No significant differences were observed in the degree of ST-segment elevation in leadsⅡandⅢor the magnitude of ST-VF among various coronary artery segment lesions.ST-A_(F)and ST_(Ⅱ)/ST_(Ⅲ)values showed significant differences among different coronary artery segment lesions,with ST-A_(F)and ST_(Ⅱ)/ST_(Ⅲ)values being mathematically interchangeable.ROC curve analysis revealed a cutoff value of≥114°for RCA proximal-middle segment lesions(AUC:0.96,95%CI:0.95-0.98),a cutoff value of≤94.46°for LCX proximal segment lesions(AUC:1.0,95%CI:1.0),and an inability to effectively distinguish between LAD middle-distal segment lesions and RCA distal segment or LCX distal segment lesions,the difference was not statistically significant(P>0.05).Conclusion ST-A_(F)(or ST_(Ⅱ)/ST_(Ⅲ)values)can effectively differentiate between RCA proximal-middle segment lesions and LCX proximal segment lesions but are not effective in distinguishing LAD middle-distal segment,RCA di

关 键 词：心肌梗死 梗死相关动脉 ST段额面向量 心电描记术 

分 类 号：R540.4[医药卫生—心血管疾病]