心电图有心肌缺血改变而冠状动脉造影正常者的冠状动脉血流的意义  

Significance of coronary artery flow in patients with normal coronary angiogram but myocardial ischemia detected by electrocardiography

作　　者：金振一[1] Bela Merkely 丁大植[1] 崔兰[1] 沈铁宽[1] 

机构地区：[1]延边大学医学院附属医院心内科,吉林延吉133000 [2]匈牙利赛梅尔维斯大学医学院心内科

出　　处：《中国心血管杂志》2004年第3期175-176,183,共3页Chinese Journal of Cardiovascular Medicine

摘　　要：目的　以计帧法评价心电图有心肌缺血改变而冠状动脉造影正常者的相关冠状动脉血流的意义。方法　静息心电图或踏板运动试验 (treadm ill test,TMT)有缺血改变 (连续 2个以上相关导联 ST段水平型或下斜型压低≥0 .0 5 m V或 T波深倒置 )但冠状动脉造影正常的 19例患者为缺血组。有心绞痛样症状而静息心电图、踏板运动试验以及冠状动脉造影正常的 5 2例为对照组。测定缺血相关性冠状动脉血流心肌梗死溶栓治疗试验 (thrombolysisin myocardial infarcton,TIMI)计帧值 (frame count,TIMI- FC)。结果　缺血组心电图示前壁心肌缺血者的冠状动脉前降支血流和下壁缺血者的右冠状动脉血流以及高侧壁缺血者的左回旋支血流的 TIMI- FC值显著大于对照组(分别为 35 .3± 16 .1vs19.9± 13.7,P<0 .0 5 ;38.9± 11.7vs2 1.7± 14 .1,P<0 .0 5及 35 .9± 16 .7vs.14 .1± 9.5 ,P<0 .0 1) ;TIMI- FC测定结果以 <2 7为血流正常 ,≥ 2 7为血流缓慢。血流缓慢 (slow coronary flow,SCF)者 2 2例 ,血流正常 (norm al coronary flow,NCF)者 4 9例。SCF者中心电图有缺血改变的患者 (15例 ,6 8.2 % )显著多于 NCF者中心电图有缺血的患者 (4例 ,8.2 % ) ;NCF者中心电图正常者 (4 5例 ,91.8% )显著多于 SCF者中心电图正常者(7例 ,Objective To evaluate coronary flow by thrombolysis in Myocardial Infarction(TIMI) frame count(TIMI-FC) in patients with normal coronary angiogram but myocardial ischemia detected by electrocardiogram(ECG). Methods Nineteen patients of normal coronary angiogram but with myocardial ischemia detected by ECG(downsloping or horizontal depression≥0.05mV of ST segments or inverted T waves in resting ECG or treadmill test in several leads)consisted of ischemic group. Fifty-two patients of normal angiogram and ECG but with angina pectoris like symptom consisted of control group. TIMI-FC of related coronary artery flow of all patients were analyzed. Results The value of TIMI-FC of left anterior descending artery of patients with anterior myocardial ischemia detected by ECG in ischemic group was much higher than that of patients with normal ECG in the control group(35.3±16.1 vs. 19.9±13.7, P<0.05), and the same results were also found in the right and left circumflex coronary artery in ischemic and control groups(38.9±11.7 vs. 21.7±14.1, P<0.05; 35.9±16.7 vs.14.1±9.5, P<0.01). Normal coronary artery flow(NCF) defined as if value of TIMI-FC<27 and slow coronary artery flow(SCF) as TIMI-FC≥27. SCF group consisted of 22 cases and NCF 49. The patients of myocardial ischemia detected by electrocardiography in the SCF group(15 cases, 68.2%) were significantly more than that in the NCF group (4 cases, 8.2%), P<0.01. Meanwhile, the patients of normal ECG in the NCF group(45 cases,91.8% more than that in SCF group(7 cases, 31.8%), P<0.01. Conclusion The patients with normal coronary angiography but manifestations of myocardial ishemia on ECG had decreased coronary artery flow and the phenomenon of TIMI-FC could be used as a marker of myocardial ischemia.

关 键 词：冠状动脉血管造影术 心电描记术 计帧值 

分 类 号：R540.41[医药卫生—心血管疾病] R816.2[医药卫生—内科学]