急性下壁心肌梗死心电图QRS波终末变形的意义

Significance of terminal QRS distortion on the electrocardiogram in acute inferior myocardial infarction

目的通过与冠状动脉造影对比，探讨急性下壁心肌梗死时患者的心电图QRS波终末变形能否作为梗死相关动脉的判定标准。方法对比57例急性下壁心肌梗死患者，其中右冠状动脉（RCA）闭塞（RCA闭塞组）29例、左回旋支（LCX）闭塞（LCX闭塞组）28例，分析患者胸痛发作12h内的心电图变化特点。结果RCA闭塞组Ⅱ、Ⅲ、aVF导联QRS波终末变形的发生率为44．8％（13／29），LCX闭塞组的发生率为39．3％（11／28），两组比较差异无统计学意义（P〉0．05）。RCA闭塞组V4R～V5R导联QRS波终末变形的发生率为17．2％（5／29），LCX闭塞组的发生率为7．1％（2，28），两组比较差异无统计学意义（P〉0．05）。RCA闭塞组V7～V9导联QRS波终末变形的发生率为6．9％（2／29），低于LCX闭塞组的发生率53．6％（15／28），两组比较差异有统计学意义（P〈0．01）。V7～V9导联QRS波终末变形在急性下壁心肌梗死时梗死相关动脉为LCX的判定敏感度、特异度、阳性预测值、阴性预测值分别为53．6％（15，28）、93．1％（27／29）、88．2％（15／17）、67．5％（27，40）。V7～V9导联QRS波终末变形诊断急性下壁心肌梗死时梗死相关动脉为LCX的曲线下面积为0．733（95％c，0．599～0．868）。结论V7～V9导联QRS波终末变形对急性下壁心肌梗死时梗死相关动脉的识别有一定的临床价值。

Objective To investigate whether terminal QRS distortion on the electrocardiogram in acute inferior myocardial infarction could be as a standard for the infarct-related artery, through comparing to coronary angiography. Methods Fifty-seven patients with acute inferior myocardial infarction were enrolled, among which, the right coronary artery （RCA） occlusion （RCA occlusion group） was present in 29 cases, and left circumflex coronary artery （LCX） occlusion （LCX occlusion group） was in 28 cases. Thechanges of electrocardiogram was analyzed in 12 hours after the acute episode. Results The incidence of terminal QRS distortion in leads II, !II, aVF in RCA occlusion group was 44.8%（13/29） and 39.3%（ 11/28 ） in LCX occlusion group,and there was no significant difference （P 〉 0.05）. The incidence of terminal QRS distortion in leads V4R -V5R in RCA occlusion group was 17.2%（5/29） and 7.1%（2/28） in LCX occlusion group , and there was no significant difference （P 〉 0.05 ）. The incidence of terminal QRS distortion in leads V7 - V9 in RCA occlusion group was 6.9%（2/29）, which was lower than that in LCX occlusion greup[53.6% （15/28） ], and there was significant difference （P 〈 0.05）. For identifying LCX as the infarct-related artery of acute inferior myocardial infarction, the sensitivity, specificity, positive and negative value in terminal QRS distortion in leads V7 - V9 were 53.6% （15/28） ,93.1% （27/29）, 88.2% （15/17） ,67.5% （27/40）. The area under curve of terminal QRS distortion in leads V7 - V9 in identifying Lcx as the infarct-related artery of acute inferior myocardial infarction was 0.733 （95% Cl 0.599 -0.868）. Conclusion Terminal QRS distortion in leads V7 - V9 may be of diagnostic value in identifying the infarct-related artery in acute inferior myocardial infarction.