头胸导联及常规导联心电图对右室心肌梗塞诊断的对比研究

Comperative study the clinical implication of ECG head-chest leads vs wilson precordial leads in the diagnostic of right ventricular myocardial infarction(RVMI)

对65例下壁心肌梗塞患者以血流动力学为诊断右室心肌梗塞（RVMI）的相关指标，对比头胸导联心电图（HCECG）及常规心电图（WECG）诊断RVMI的价值，结果发现47例合并有RVMI，18例无RVMI。两种ECG比较HCECGV3R－V7RST抬高幅度大，持续时间长，受V2ST段降低的影响小，对RVMI诊断敏感性增高，特异性无变化。同时，V3RQ波诊断RVMI敏感性78％，特异性88．2％，对亚急任期RVMI也有一定诊断价值。

In order to evaluate the clinical significance of ECG Head-Chest leads vs Wilson Precordial leads in the diagnosis of right ventricular myocardial infarction,65 patients suffered from acute myocardial infarction (AMI) with ECG Head-Chest leads,Wilson Precordial leads and hemodynandc data were ana-lyzed. Patients with hemodynamic data of MRAP/PCWP>0. 6 or MRAP>10 mmHg and RVSWI<5g.m/m2 were designated as RVMI cases. In our series of 65 cases AMI patients,47 were diagnosed as RVMI cases,and the other 18 cases were without RVMI. In cases of RVMI changes in Lead V3R-V7R between Hea-Chest leads and those of Wilson Precordial leads were compared. ST-segment elevation was more marked and persisted for a longer duration in Head-Chest leads than those of Wilson Precordial leads- While a reference range of ST-elevation>0. 5mm or >1mm in leads V3R-V7R was used as the criterion for the diagnosis of RVMI,Head-Chest leads wer-e more sensitive than the Wilson Precordial leads (sensitivity 75. 6%~80.4% vs 48. 9%-55.6%;65.9%-75. 6% vs 33. 3%-35. 6% respectively). There was no difference in specificity between these two leads system. A combination of changes (ST-elevation>1 mm)in Head-Chest 5 leads (V3R-V7R) would be more accurate for the diagnosis of RVMI (sensitivity 90. 2% ;speificity 82. 4%). A Q-Wave of V3R on Head-Chest lead system might be of some value indicative of the subacute phase of RVMI (sensitivity 78%;specificity 88.2 %) Our results might be applicable for the diag-nosis of RVMI