急性前壁心肌梗死T波形态与ST段抬高预测心尖部室壁瘤的对比研究

Comparison between T wave evolusion of V_1 lead and persistent ST elevation after acute anterior myocardial infarction for diagnosing left ventricular anteroapical aneurysm

目的 对比评价前壁急性心肌梗死 (AMI)后V1导联T波直立或低平与胸前导联ST段持续抬高对心尖部室壁瘤的诊断价值。方法 首次前壁AMI患者 45例 ,以发病 2周后左心室造影诊断的室壁瘤为标准 ,计算V1导联T波直立或低平及胸前导联ST段持续抬高预测心尖部室壁瘤的敏感性、特异性和准确性。结果 45例患者中 17例诊断室壁瘤 ,检出率为 3 7 8%。胸前导联ST段持续抬高、V1导联T波直立或低平和二者结合预测心尖部室壁瘤的敏感性分别为 82 4%、82 4%和 70 6% ;特异性分别为64 3 %、5 7 1%和 75 % ;准确性分别为 71 7%、66 7%和 73 3 %。结论 V1导联T波直立或低平预测前壁AMI心尖部室壁瘤与ST段抬高有着同样的临床价值 ,二者相结合 。

Objective To compare the accuracy of T wave evolusion/flattening of V 1 lead with persistent ST elevation of V 1～6 for diagnosing left apical ventricular aneurysm.Method Fourty-five patients with acute anterior myocardial infarction underwent left ventriculography two weeks from onset for the diagnosis of left ventricular anteroapical aneurysm in order to calculate the sensitivities,specificities and accuracies of non-inversion of T wave of V 1 lead and persistent ST elevation for diagnosing left ventricular anteroapical aneurysm.Compare the sensitivities,specificities and accuracies between non-inversion of T wave of V 1 lead and persistent ST elevation.Result Seventeen were diagnosed as left ventricular anteroapical aneurysm,and the rate is 37.8%.The sensitivities,specificities and accuracies of persistent ST elevation for diagnosing left ventricular anteroapical aneurysm were 82.4%,64.3%,71.7% respectively.Those of non-inversion of T wave of V 1 lead were 82.4%?57.1% and 66.7%.There were no significant difference between them(P>0.05).The sensitivities,specificities and accuracies of persistent ST elevation combined with non-inversion of T wave of V 1 lead for diagnosing left ventricular anteroapical aneurysm were 70.6%?75%?73.3% respectively.Compared with persistent ST elevation,the sensitivity is lower,but the specificity and accuracy are higher.Conclusion Non-inversion of T wave of V 1 lead has the same value with persistent ST elevation for diagnosing left ventricular anteroapical aneurysm,which combining with persistent ST elevation would improve the value of diganosis.