冠状动脉造影评价ST↑_(Ⅲ>Ⅱ)与ST_(V4R)↑诊断右心室心肌梗死的价值

Evaluation of the value of ST elevation in lead III greater than lead II and ST elevation in lead V4R for diagnosing right ventricular myocardial infarction by coronary angiography

目的以冠状动脉造影(coronary angiography,CAG)显示右冠状动脉(right coronary artery,RCA)右室支近端闭塞作为右心室心肌梗死(right ventricu lar myocard ial infarction,RVM I)的诊断依据,评价心电图Ⅲ导联ST段抬高幅度大于Ⅱ导联(ST↑Ⅲ>Ⅱ)与V4R导联ST段抬高(STV4R↑)的诊断价值。方法选择发病12小时内入院的急性下壁M I患者158例,分别计数存在ST↑Ⅲ>Ⅱ或STV4R↑的病例数。根据CAG结果判断RCA或LCX的闭塞部位,以RCA右室支近端闭塞作为RVM I的诊断依据,计算并比较ST↑Ⅲ>Ⅱ与STV4R↑诊断RVM I的敏感性和特异性。结果158例急性下壁M I患者中,CAG证实为RCA右室支近端闭塞即合并RVM I者69例,其余89例为RCA右室支远端或LCX闭塞。ST↑Ⅲ>Ⅱ诊断RVM I的敏感性明显高于STV4R↑(98.6%vs 66.7%,P<0.01),而特异性前者明显低于后者(58.4%vs 80.9%,P<0.01)。当两种心电图指标并存(ST↑Ⅲ>Ⅱ+STV4R↑)时,其敏感性不低于STV4R↑(P>0.05),而特异性高于两者单独存在(P<0.05)。结论以CAG结果为依据评价急性下壁M I时Ⅲ导联ST段抬高幅度大于Ⅱ导联与V4R导联ST段抬高诊断RVM I的价值具有较大临床意义,前者敏感性较高,后者特异性较高,两者并存时进一步提高诊断的准确性。

Objective To evaluate the diagnostic value of ST elevation in lead Ⅲ〉 Ⅱ （ ST ↑Ⅲ 〉Ⅱ ） compared with ST elevation in lead V4R （STV4R↑ ）in diagnosing right ventrieular myocardial infarction（ RVMI）, based on the occlusion of RCA proximal to the right ventricular branch shown by coronary angiography （CAG）. Methods One hundred and fifty-eight patients with acute inferior MI admitted within 12 hours from onset of infarct symptoms underwent emergency CAG, Each patient was analyzed for the presence of ST ↑Ⅲ 〉 Ⅱ and STV4R↑. The sensitivity and specificity of ST ↑Ⅲ〉Ⅱ and STV4R ↑ for diagnosing RVMI were calculated and compared. Results In 69 of 158 patients, the occlusion was proximal to the right ventricular branch of RCA while in 89 patients it was distal to the right ventricular branch of HCA or in LCX. The sensitivity of ST ↑Ⅲ〉Ⅱfor diagnosing RVMI was significantly higher than that of STV4R↑ （98.6% vs 66.7%, P 〈 0.01 ）, but the specificity of ST ↑ Ⅲ〉Ⅱ was markedly lower than that of STV4R ↑ （58.4% vs 80.9% ,P 〈0.01 ）. In patients with both ST ↑ Ⅲ〉Ⅱ and STV4R ↑ ,the sensitivity was no lower than that of ST↑Ⅲ〉Ⅱ （ P 〉 0.05 ）, while the specificity was higher than that of either ST ↑Ⅲ〉Ⅱ or STV4R ↑. Conclusion Based on the findings of CAG, ST↑Ⅲ〉Ⅱ and STV4R ↑ are of higher sensitivity and higher specificity, respectively. For diagnosing RVMI associated with acute inferior MI , coexisting ST ↑ Ⅲ〉Ⅱ and STV4R↑ can improve the accuracy for diagnosing RVMI.