心电图对心尖球形综合征和早期ST段抬高心肌梗死的诊断价值研究

Value of Electrocardiographic Characteristics between Transient Left Ventricular Apical Ballooning Syndrome and Anterior ST Segment Elevation Myocardial Infarction

目的评价心电图鉴别诊断心尖球形综合征和早期ST段抬高心肌梗死的价值。方法 18例心尖球形综合征和36例左前降支冠脉血栓形成导致早期ST段抬高心肌梗死匹配。结果所有患者都是女性,心率、PR间期、QRS时间和QT间期两组没显著差异,早期ST段抬高心肌梗死的ST段抬高对比心尖球形综合征更加明显,回归分析发现V2导联ST段抬高小于1.75 mm和V3导联ST段抬高小于2.5 mm预测心尖球形综合征(敏感度67%,特异度94%),条件逻辑回归分析得到这样一个等式:心尖球形综合征ST抬高之和(3×V2导联ST抬高+V3导联ST抬高+2×V5导联)小于11.5 mm。结论心电图可为鉴别女性心尖球形综合征和早期ST段抬高心肌梗死提供帮助。对于区分两组之间的紧急症状不能提供足够可靠的预测价值。

Objective To assess the value of electrocardiographic （ECG） diagnosis for differentiation between transient left ventricular apical ballooning syndrome （TLVABS） and anterior ST segment elevation myocardial infarction （STEMI） . Methods Totally 18 consecutive patients with TLVABS who were matched with 36 subjects presenting with acute anterior STEMI due to atherothrombotic left anterior descending coronary artery occlusion. Results All patients with TLVABS were women. The heart rate-, PR interval, QRS duration, and corrected QT interval were similar between groups （ P 〉 0. 05 ） . Distribution of ST elevation was similar, but patients with anterior STEMI exhibited greater ST elevation. Regressive analysis indicated that the com- bination of ST elevation in lead V2 of less than 1.75 mm and ST - segment elevation in lead V3 of less than 2. 5 mm was a sugges- tive predictor of TLVABS （sensitivity, 67% ; specificity, 94% ） . Conditional logistic regression indicated that the formula： （3 x ST - elevation lead V2） ＋ （ ST - elevation V3） ＋ （2 × ST - elevation VS） allowed possible discrimination between TLVABS and anterior STEMI with an optimal cutoff level of less than 11.5 mm for TLVABS. Conclusion The ECG findings are relatively subtle for differentiation between patients with TLVABS patients with STEMI in women. However these ECG findings do not have sufficient predictive value to allow reliable emergency differentiation of these syndromes.