aVL导联判断急性下壁心肌梗死合并右室心肌梗死的价值

Value of aVL lead in diagnosing right ventricular infarction involvement in patients with acute inferior myocardial infarction.

目的评价aVL导联ST段压低对诊断急性下壁心肌梗死合并右室心肌梗死的价值。方法回顾分析55例急性下壁心肌梗死患者的资料,合并右室心肌梗死26例(以V_4R导联ST段抬高≥1 mm为诊断标准)。以aVL导联ST段压低＞1 mm为另一诊断合并右室心肌梗死的标准。结果aVL导联ST段压低＞1 mm(合并右室心肌梗死)25例,ST段压低≤1 mm(无合并右室心肌梗死)30例。25例中符合V_4R导联ST段抬高≥1 mm诊断标准的有22例,而30例中有4例。灵敏度、特异度、准确率分别为85%、90%和87%,阳性和阴性预计值分别为88%和87%。结论aVL导联ST段压低8＞1 mm诊断急性下壁心肌梗死患者合并右室心肌梗死有较高的灵敏性、特异性和准确性。急性下壁心肌梗死时,aVL导联ST段压低＞1 mm可作为提示急性下壁心肌梗死合并右室心肌梗死的简便方法。

Objective To assess the the value of ST-segment depression on lead aVL in diagnosing right ventricular（RV） infarction in patients with acute inferior myocardial infarction（MI）. Methods 55 patients with acute inferior MI were included in this study. The diagnosis of acute inferior MI was based on clinical history,CK-MB enzyme, and the ST-segment elevation ≥ 1 mm on at least two of Ⅱ, Ⅲ, aVF leads. RV myocardial infarction involvement was diagnosed by ST-segment elevation ≥ 1 mm on lead V4R（n= 26）. ST-segment depression ） 1 mm on lead aVL was another diagnostic criterion for RV infarction involvement in patients with acute inferior MI. Results 25 patients with ST-segment depression ） 1 mm on lead aVL were found in 55 patients with acute inferior MI, and in only 22 patients with right ventricular myocardial infarction. The other 4 patients with right ventricular myocardial infarction were found in another 30 patients with ST-segment depression （ 1 mm on lead aVL. Conclusion ST-segment depression ） 1 mm on lead aVL has high sensitivity（85 % ）, specificity（90 % ） , accuracy 87 % , positive and negative predictive value（88%, 87%）in diagnosing RV infarction involvement in patients with acute inferior MI. Therefore, it is possible to identify RV infarction involvement in patients with acute inferior MI by using a simple diagnostic criterion of ST-segment depression 〉 1 mm on lead aVL. （Shanghai Med J, 2006, 29..625-627）