立体心电向量图对心肌梗死病变血管定位的价值

Evaluation of 3-dimension vectrocardiography for localizing the infarction related artery in myocardio-infarction

目的对比分析常规心电图(ECG)和立体心电向量图(3D-VCG),评价3D-VCG在心肌梗死相关动脉(IRA)定位上的应用价值。方法 114例临床确诊心肌梗死患者,经冠状动脉造影,将冠状动脉单支完全闭塞或狭窄≥75%者,分成左前降支(LAD)、左回旋支(LCX)、右冠状动脉(RCA)共3个IRA组,分别分析其ECG和3D-VCG的分区定位特点。结果以3D-VCG心肌梗死诊断标准之前壁区定位LAD,高侧壁定位LCX,下壁定位RCA,阳性检出率高于常规ECG(分别为:91.7%比50%,75%比12.5%,70%比3.5%,均为P<0.01)。阴性检出率:LAD、LCX和RCA组3D-VCG显著低于ECG(2.7%比33.3%,2.1%比50%,0比30%,均为P<0.01)。结论 3D-VCG对心肌梗死IRA有定位诊断价值,且较常规ECG为优。

Objective To evaluate the value of 3-dimension electrocardiography （3D-VCG） in localizing the infarction related artery （IRA） in myocardial-infarction （MI）. Methods A total of 114 MI cases with coronary arteriography were divided into 3 IRA （artery occlusion≥75% ） groups： 36 cases in left anterior descending artery （LAD） group, 48 cases in left circumflex artery （LCX） group and 30 cases in right coronary artel-y （RCA） group. 3D-VCGs and ECG of each patients were analyzed. Results There was significant deference both in positive and negative detective rate between 3D-VCG and ECG positive detective rate： LAD group： 91.7% vs. 50% in anterior wall （P 〈0. 01 ） ; LCX group： 75% vs. 12. 5% in high lateral wall（P〈0.01）; RCA gruup： 70% vs. 6. 7% in inferior wall（P〈0.01）; negative detective rate： The negative detectable rates of 3D-VCG in LAD, LCX and RCA groups were significantly lower than those of ECG （2.8% vs. 33.3%, P〈0.01; 2. 1% vs. 50%, P〈0.01; Ovs. 30%, P〈0.01）.Conclusions In diagnosing and locating IRA, 3D-VCG is somehow more accurate than routine ECG.