aVR导联ST段抬高在急性ST段抬高型心肌梗死中的意义

Value of ST segment elevation of aVR lead in patients with acute ST segment elevation myocardial infarction

目的分析急性ST段抬高型心肌梗死患者aVR导联趼段抬高（aVRSTE）对左主干病变或等同病变的诊断价值及预后的预测价值：方法对入选140例患者，行心肌酶检测、心电图、急诊冠状动脉造影及超声心动图检查[均在冠造术后（10±2）d]。分析aVRSTE（≥0．5mm）对STEMI患者左主干病变（左主干急性闭塞或狭窄≥50％）或左前降支近端急性闭塞、次全闭塞（被定义为左主干等同病变）的诊断价值，并比较aVRSTE和不抬高患者的KILLIP分级及心脏收缩功能。结果（1）aVRSTE诊断左主干病变的敏感性、特异性、阳性预测值、阴性预测值分别为72．73％（8／11）、83．72％（108／129）、27．59％（8／29）、97．30％（108／111）；（2）aVRSTE诊断左主干病变或等同病变的敏感性、特异性、阳性预测值、阴性预测值分别为41．86％（18／43）、88．66％（86／97）、62．07％（18／29）、77．48％（86／111）；（3）aVRS3E联合STaVR-STv1〉0诊断左主干病变的敏感性、特异性、阳性预测值、阴性预测值分别为63．64％（7／11）、98．45％（127／129）、77．78％（7／9）、96．95％（127／131）；（4）按aVR导联ST段是否抬高分为抬高组29例，非抬高组111例。两组KILLIP分级（P〈0．05）和左室射血分数[（53．29±11．29）％vs．（59．45±10．17）％，P〈0．05]差异具有统计学意义。结论在STEMI患者中：（1）若aVRSTE，考虑左主干病变或左前降支近端急性病变可能性大，若ST aVR-STv1〉0，则进一步支持左主干病变；（2）aVRSTE者近期心脏收缩功能损害较无抬高者明显，预后可能较差。

Objective To asses the value of ST segment elevation of aVR lead （aVRSTE） in patients with acute ST segment elevation myocardial infarction （STEMI）. Method Myocardial enzymes detection, electrocardiography, emergency cornary artery angiography, echocardiography [ taken （10± 2） days after emergency cornary artery angiography] were obtained and analyzed in 140 consecutive patients with STEMI enrolled in this study. The value of aVRSTE （≥0.05 mV） was assessed for detecting left main stem lesions（defined as ≥50% stenosis of or acute embolism of left main stem）or its equivalent （defined as total or subtotal acute occlusion of left anterior descending artery） , and predicting the left ventricular systolic function after myocardial infarction. Results The sensitivity, specificity, positive predictive value and negative predictive value of aVRSTE in detection of left main stem lesions were 72.73 % （8/11 ）, 83.72 % （108/129）, 27.59 % （8/29） and 97.30% （ 108/111 ）, respectively; in detection of left main stein lesions or its equivalent, they were 41.86 % （18/43）, 88.66 % （86/97）, 62.07 % （ 18/ 29）, 77.48 % （86/111 ） ; aVRSTE were combined with STaVR-STv1 〉 0 to detect left main stem lesions, the sensitivity, specificity, positive predictive value and negative predictive value were 63.64% （7/11 ）, 98.45% （ 127/ 129） ,77.78% （7/9）, 96.95% （127/131）. Patients were divided into two groups： groups A with aVRSTE and group B without aVRSTE. KILLIP class, and left ventricular ejection fraction （LVEF） in group A was higher than those in group B （ P 〈 0.05）. Conclusions For patients with STEMI ： （ 1 ） aVRSTE indicated left main stem lesions or its equivalent; if combined with STaVR-STv1 〉 0, it indicated left main stem lesions more strongly; （2） aVRSTE predicted poorer left ventricular systolic function short time after STEMI.