陈旧性前壁心肌梗死R波递增不良的研究

Poor R-wave progression in patients with old anterior myocardial infarction

目的探讨心电图R波递增不良(PRWP)在陈旧性前壁心肌梗死(MI)中的发生率及与心肌灌注断层显像前壁心肌放射性缺损节段数和分布的关系。方法回顾性分析2000-2006年北京医院核医学科连续进行三磷酸腺苷负荷心肌灌注断层显像检查诊断前壁心肌梗死病例的心电图,应用常规心电图R波递增不良的诊断标准对药物负荷检查前卧位标准12导联心电图进行分析诊断,将陈旧性前壁心梗不同心电图表现同药物负荷心肌灌注断层显像前壁心肌放射性缺损节段数和分布进行比较。结果心肌灌注断层显像检出前壁心梗106例,90例符合入选标准,前壁Q波心肌梗死26例,前壁非Q波心肌梗死64例,前壁非Q波心肌梗死患者R波递增不良发生率为20.3%￣42.2%,前壁Q波心肌梗死心肌灌注断层显像前壁心肌放射性缺损节段数显著多于非Q波心肌梗死,R波递增不良前壁非Q波心肌梗死前壁心肌放射性缺损节段数多于R波递增不良阴性前壁非Q波心肌梗死。前壁心肌核素放射性缺损节段分布:R波递增不良前壁非Q波心肌梗死中部前壁、前间壁显著多于R波递增不良阴性前壁非Q波心肌梗死,而R波递增不良阴性前壁非Q波心肌梗死基底部前侧壁显著多于R波递增不良前壁非Q波心肌梗死(Zema标准)。结论陈旧性前壁心梗R波递增不良非常常见,不同心电图表现同心肌灌注断层显像前壁心肌放射性缺损节段数和分布相关。

Objective To investigate the incidence of Electrocardiographic poor R-wave progression （PRWP） in old anterior myocardial infarction（MI） and the relationship between electrocardiogram（ECG） and the quantity and location of the segments of scintigraphic anterior defects. Methods The resting ECGs of consecutive patients undergoing single photon emission computed tomography with pharmacologic stress test from 2000 to 2006 in Beijing Hospital were analyzed retrospectively. Standard PRWP criteria were used to analyze the ECGs, It was noted whether the pa- tients met the PRWP criteria or not. Comparing subjects＇ ECGs and the quantity and location of the segments of scintigraphic anterior defects. Results 106 subjects had scintigraphic anterior MI. Inclusion criteria were met by 90 subjects. 26 subjects had Q wave anterior MI. 64 subjects had non-Q wave anterior MI. Of subjects with non-Q wave anterior MI, 20.3% to 42.2% met PRWP criteria. The quantity of the segments of scintigraphic anterior defects in the subjects with Q wave anterior MI was more than that in the subjects with non-Q wave anterior MI. The quantity of the segments of scintigraphic anterior defects in the subjects with non-Q wave anterior MI meeting PRWP criteria was more than that in the subjects with non-Q wave anterior MI not meeting PRWP criteria. The incidence of scintigraphic anterior and anterior septal defects at medial wall in the subjects with non-Q wave anterior MI meeting PRWP criteria were more than that in the subjects with non-Q wave anterior MI not meeting PRWP criteria, the incidence of scinti- graphic anterior lateral defects at basal wall in the subjects with non-Q wave anterior MI meeting PRWP criteria was less than that in the subjects with non-Q wave anterior MI not meeting PRWP criteria. Conclusions PRWP was com- mon in patients with old anterior MI. The ECGs in patients with old anterior MI were correlate with the quantity and location of the segments of scintigraphic anterior defects.