急性下壁心肌梗死心电图aVL导联QRS波群变化的临床意义

Implication of configuration of QRS in lead aVL in inferior wall acute myocardial infarction

目的 探讨下壁急性心肌梗死 (AMI)时患者的心电图aVL导联QRS波群变化能否作为罪犯血管的判定标准。方法 比较 6 0例下壁AMI患者aVL导联QRS波群变化与选择性冠状动脉造影结果的相关性 ,分析aVL导联QRS波群两种模式 (Ⅰ型 :S/R≤ 1/ 3,ST段抬高≤ 1mm ;Ⅱ型 :S/R >1/ 3,ST段抬高 >1mm)对判断下壁AMI罪犯血管的临床价值。结果 aVL导联的Ⅰ型QRS波群改变在左冠状动脉回旋支 (LCX)闭塞组出现率为 89% ,右冠状动脉 (RCA)闭塞组为 2 4 % (P =0 .0 0 1)。Ⅱ型改变在LCX组出现率 11%、RCA组为 76 % (P =0 .0 0 1)。Ⅰ型心电图变化预测LCX闭塞的敏感度为 89% ,特异度为 76 %。Ⅱ型心电图改变预测RCA闭塞的敏感度为 76 % ,特异度为89%。结论 aVL导联的Ⅰ型QRS波群变化是判断LCX型AMI敏感、特异的预测指标 。

Objective To investigate whether the configuration of QRS complex in lead aVL in inefrior wall acute myocardial infarction(AMI)could be as a standard for culprit artery.Methods The relation between the configuration of QRS complex in lead aVL and the results of coronary angiography was studied in 60 inferior wall AMI patients,the values of two patterns(pattern Ⅰ:S/Rwave ratio≤1/3,ST elevation≤1 mm;Pattern Ⅱ:S/Rwave ratio>1/3,ST elevation>1 mm)in predicting the culprit artery of inferior wall AMI patients were investigated.Results Pattern Ⅰof QRS complex in lead aVL was found in 89% of the left circumflex(LCX)group compared with 24% of the right coronary artery(RCA)group(P= 0.001).Pattern Ⅱwas found in only 11% of the LCX group compared with 76% of the RCA group(P= 0.001).Pattern Ⅰhad a sensitivity of 89% and specificity of 76% to predict LCX related AMI.Pattern Ⅱhad a sensitivity of 76% and specificity of 89% to predict RCA related AMI.Conclusions Pattern Ⅰof QRS complex in lead aVL is a sensitive and specific marker for LCK artery AMI,whereas pattern Ⅱis suggestive of RCA-related AMI disease.