CAJ | 학술논문

目的分析急性ST段抬高型心肌梗死患者aVR导联ST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(≥>0.5 mm)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%(8/1)、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)aVRbqE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)aVILSTE者近期心脏收缩功能损害较无抬高者明显,预后可能较差.
목적 분석급성ST단태고형심기경사환자aVR도련ST단태고(aVRSTE)대좌주간병변혹등동병변적진단개치급예후적예측개치. 방법 대입선140례환자,행심기매검측、심전도、급진관상동맥조영급초성심동도검사[균재관조술후(10±2)d].분석aVRSTE(≥>0.5 mm)대STEMI환자좌주간병변(좌주간급성폐새혹협착≥50%)혹좌전강지근단급성폐새、차전폐새(피정의위좌주간등동병변)적진단개치,병비교aVRSTE화불태고환자적KILLIP분급급심장수축공능. 결과 (1)aVRSTE진단좌주간병변적민감성、특이성、양성예측치、음성예측치분별위72.73%(8/1)、83.72%(108/129)、27.59%(8/29)、97.30%(108/111);(2)aVRSTE진단좌주간병변혹등동병변적민감성、특이성、양성예측치、음성예측치분별위41.86%(18/43)、88.66%(86/97)、62.07%(18/29)、77.48%(86/111);(3)aVRbqE연합STaVR-STv1>0진단좌주간병변적민감성、특이성、양성예측치、음성예측치분별위63.64%(7/11)、98.45%(127/129)、77.78%(7/9)、96.95%(127/131);(4)안aVR도련ST단시부태고분위태고조29례,비태고조111례.량조KILLIP분급(P<0.05)화좌실사혈분수[(53.29±11.29)%vs.(59.45±10.17)%,P<0.05]차이구유통계학의의. 결론 재STEMI환자중:(1)약aVRSTE,고필좌주간병변혹좌전강지근단급성병변가능성대,약ST aVR-STv1>0,칙진일보지지좌주간병변;(2)aVILSTE자근기심장수축공능손해교무태고자명현,예후가능교차.
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, electrocar-dingraphy, emergency eornary artery angiography, echoeardiography [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 de-scending artery), and predicting the left ventricular systolic function after myocardial infarction. Results The sensitivity, specificity, positive predictive value and negative predictive value of aVRSIE 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 stem lesions or its equivalent, they were 41.86 % (18/43), 88.66% (86/97), 62.07 % (18/29), 77.48% (86/111); aVRSYE were combined with STaVR-STv1>0 to detect left main stem lesions, the semi-tivity, 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 aVRSIE and group B without aVRSYE. KIIJJP 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 le-sions or its equivalent; if combined with STaVR-STv1>0, it indicated left main stem lesions more strongly; (2)aVRSTE predicted poorer left ventricular systohc function short time after STEMI.