老年下壁异常q波患者头胸导联心电图表现及与冠状动脉病变的关系

Relationship between character of head-chest lead electrocardiogram and coronary lesions in elderly patients with abnormal Q waves in inferior lead

目的评价头胸导联心电图对老年患者常规心电图下壁导联异常q波的鉴别作用。方法常规导联心电图Ⅲ、aVF导联同时存在异常q波老年患者55例，根据是否有急性心肌梗死病史分为陈旧心肌梗死组（心肌梗死组）和非陈旧性心肌梗死组（非心肌梗死组）。患者均行冠状动脉CT血管成像（CTA）检查了解冠状动脉病变程度。对比常规心电图下壁导联Ⅱ、Ⅲ、aVF与之对应的头胸导联下壁左腋前线、前正中线旁、右腋前线导联的心电图，对各个导联q波的出现频率进行比较，并与冠状动脉CTA结果比较，计算各导联对于心肌梗死诊断的敏感和特异程度。结果心肌梗死组患者22例（100％）右冠状动脉均见重度狭窄，非心肌梗死组10例（30．3％）轻度狭窄，23例（69．7％）中度狭窄。心肌梗死组头胸导联与常规心电图相对应部位的导联q波出现率差异无统计学意义（均P〉0．05）。非心肌梗死组左腋前线、Ⅱ、右腋前线、Ⅲ、前正中线旁、aVF导联无q波而排除陈旧心肌梗死诊断的特异性分别为100％、97．0％（32／33）、97．o％（32／33）、15．2％（5／33）、100％、39．4％（13／33）。结论头胸导联q波改变与冠状动脉血管病变符合度较高，因此头胸导联对常规导联下壁的异常q波的临床意义有一定的鉴别作用。

Objective To evaluate the ability of further discriminating diagnosis of the headchest lead electrocardiogram （HCECG） in elderly patients with abnormal Q waves in routine lead electrocardiogram （RLECG） in inferior lead. Methods The 55 male patients, aged 65-88 years, with abnormal Q waves in both lead HI and aVF were selected and divided into two groups., myocardial infarction （MI） group and non-MI group, according to if the patient had a history of acute MI. All the patients accepted examination of coronary computed tomographic angiography （CTA） and ultrasound cardiogram, those with Wolff-Parkinson-White syndrome and myocardial hypertrophy were excluded. The 30 individuals of control group had no abnormal Q waves in lead II , III and aVF. HCECG and RLECG were recorded simultaneously in respective groups and occurrence rate of Q waves in correlative leads II, III, aVF and HL3, H0, HR3 were matched and compared, sensitivity and specificity were compared in respective leads. Results There were serious stenosis in 22 patients （100%） in MI group, and there were mild stenosis in 10 （30.3%） and moderate stenosis in 23 patients （69.7%） in non-MI group. There was no significant difference between HCECG and RLECG in occurrence rate of Q waves in MI group （P〉 0.05 ）. Non-MI group left anterior axillary line, II , III , right anterior axillary line, near the anterior midline, aVF without Q wave and exclusion of old MI diagnostic specificity were 100%, 97.0% （32/33）, 97.0% （32/33）, 15.2% （5/33）, 100%, 39.4% （13/33）respectively. Conclusions Pseudo-changes are rarely found in HCECG and there is a higher degree of conformity in HCECG with coronary lesions, therefore HCECG may be used to discriminate whether the inferior abnormal Q waves occurred in RLECG are truly abnormal or not.