QRS波宽度及aVR导联ST段抬高对NSTE-ACS左主干或三支病变的预测作用

目的研究非ST段抬高型急性冠脉综合征(NSTE-ACS)患者心电图的QRS波宽度及aVR导联抬高幅度对冠状动脉左主干/三支病变的诊断价值。方法分析106例NSTE-ACS患者的体表心电图QRS波宽度及aVR导联ST段抬高幅度,通过与冠状动脉造影结果对比,研究其对诊断左主干/三支病变的敏感性、特异性和相关性。结果 QRS波宽度及aVR导联ST段抬高是左主干/三支病变的独立预测因子,OR值分别为9.04(95%CI,4.88～16.7)、7.10(95%CI,4.91～76.2);QRS间期≥90ms和aVR导联ST段抬高≥0.5mm预测左主干/三支病变的敏感性及特异性分别为88%、76%及88%、86%。结论 QRS波增宽及aVR导联ST段抬高是NSTE-ACS患者左主干/三支病变较为灵敏的预测因子。     

心电图诊断左主干或多支血管病变

目的评价心电图对非ST段抬高急性冠脉综合征(NSTE-ACS)的左主干及多支血管病变的预测价值。方法回顾分析拟诊NSTE-ACS,并行冠脉造影(CAG)检查患者219例,根据CAG结果分为两组,一组为左主干和/或多支病变组(LM/M-VD),另一组为对照组。对比两组得出预测LM/M-VD的敏感性和特异性较高的心电图指标。结果多变量分析表明≥5导联ST段下移(OR:3.29,p<0.05)和aVR导联ST段抬高(OR:3.52,p<0.05)能作为LM/M-VD病变的独立预测因子。QRS时限>90ms、aVR导联ST段抬高和≥5导联ST段下移的敏感性分别为73%、65%、66%,特异性49.58%、79.84%、78.15%。结论心电图对LM/M-VD的预测是可行的,aVR导联ST段抬高和≥5导联ST段下移是预测LM/M-VD良好的心电图指标。     

平板运动试验aVR导联ST段抬高对冠状动脉左主干病变的诊断价值

目的探讨平板运动试验aVR导联ST段抬高对冠状动脉左主干病变及前降支近段病变诊断价值。方法选取18例平板运动试验阳性并伴aVR导联ST段抬高者,2周内行冠状动脉造影(CAG),以冠状动脉内径狭窄≥50%者为CAG阳性。结果左主干病变13例,前降支近段病变3例,右冠状动脉中段狭窄1例,冠状动脉造影阴性1例。平板运动试验阳性并伴aVR导联ST段抬高对左主干病变的阳性预测值为72.22%(13/18);对冠状动脉左主干及前降支近段病变的预测值为88.89%(16/18)。结论平板运动试验阳性并aVR导联ST抬高≥0.1mv对诊断冠状动脉左主干及前降支近段病变有较高的阳性预测价值。     

aVR导联ST段抬高对阵发性室上性心动过速的鉴别价值

目的探讨aVR导联ST段抬高及其持续时间对阵发性室上性心动过速(PSVT)的鉴别价值。方法126例行射频消融治疗成功的PSVT患者,其中房室折返性心动过速(AVRT)65例,房室结折返性心动过速(AVNRT)61例。分析其aVR导联ST段抬高幅度及持续时间。结果65例AVRT中aVR导联ST抬高且持续时间≥0.08s有46例,61例AVNRT中有13例,诊断AVRT的敏感性、特异性及阳性预测值分别为70.8%,78.7%,78.0%;46例aVR导联ST段抬高的AVRT中左侧旁道占38例,诊断左侧旁道的敏感性、特异性及阳性预测值分别为79.2%,52.9%,82.6%。结论aVR导联ST段抬高及其持续时间有助于鉴别阵发性室上性心动过速,且其多发生于左侧旁道。     

aVR导联ST段抬高在预测非ST段抬高型急性心肌梗死患者预后中的价值

目的探讨aVR导联ST段抬高在预测首次非ST段抬高型急性心肌梗死患者短期预后中的价值。方法分析426例非ST段抬高型急性心肌梗死患者入院心电图。结果aVR导联无ST段抬高(n=281)、抬高0.05~0.1mV(n=68)和抬高≥0.1mV(n=77)患者的住院死亡率分别是1.8%、7.4%和15.6%。调整基线预测因子和入院时ST段压低的影响,aVR导联ST段抬高0.05~0.1mV和抬高≥0.1mV患者死亡的优势比分别是4.2(95%可信区间为1.4~13.5;P<0.001)和6.1(95%可信区间为2.4~17.3;P<0.001)。住院期间复发心肌缺血事件和心力衰竭发生率随aVR导联ST段抬高程度增加而增加,而不同程度aVR导联ST段抬高患者血清肌酸激酶和肌酸激酶同工酶相似。aVR导联无ST段抬高、抬高0.05~0.1mV和抬高≥0.1mV患者左主干或3支血管病变发生率分别为16.9%、37.1%和56.2%(P<0.001)。结论首次非ST段抬高型急性心肌梗死伴aVR导联ST段抬高患者预后较差,而这种差的预后与严重的冠状动脉病变有关,对这些患者进行早期介入治疗也许有重要的益处。     

急性心肌梗死aVR导联ST段抬高的临床意义

目的 探讨体表心电图aVR导联ST段抬高对急性心肌梗死患者梗死相关血管(IRA)诊断及临床预后的意义.方法 收集2010年10月至2012年12月因急性心肌梗死入住我院的患者共240例,根据患者入院时心电图aVR导联ST段有无抬高,分为A组(AVR导联ST段抬高)80例和B组(aVR导联ST段无抬高)160例,对两组患者临床资料、冠状动脉造影结果及主要不良心血管事件进行对比.结果 ①两组患者性别、糖尿病病史、PCI病史等一般临床资料对比差异无统计学意义(P＞0.05).②两组冠状动脉造影结果比较:IRA为左主干(LM),A组9例,B组3例,两组比较差异有统计学意义(P＜0.01);IRA左主干和(或)三支血管(LM/3VD),A组46例,B组15例,两组比较差异有统计学意义(P＜0.01).③aVR导联ST抬高对IRA为左主干的敏感性及特异性分别为75％和69％,对IRA为左主干和(或)三支病变的敏感度及特异度分别为73％和81％.④住院期间主要不良心血管事件(MACE),A组36例,B组25例,两组比较差异有统计学意义(P＜0.01).⑤在住院期间,aVR导联ST段抬高(OR=10.03,95％CI=5.36～18.77,P＜0.01)是急性心肌梗死患者发生不良心血管事件的独立危险因素.结论 aVR导联ST段抬高提示急性心肌梗死患者梗死相关血管为左主干和(或)三支血管病变及住院期间不良心血管事件发生率增高.aVR导联ST段抬高对急性心肌梗死患者梗死相关血管判断及临床预后具有一定的临床指导意义.     

运动试验阳性患者aVR及V1导联ST段变化对左主干病变的预测价值

目的 评价运动试验阳性(Duke评分≤-11分)患者中aVR及V1导联ST段变化对于左主干病变的预测价值.方法 回顾性分析了 96例(Duke评分≤-11分)运动试验阳性患者,在运动试验中aVR及V1导联ST段变化,并与冠状动脉造影(CAG)结果比较.结果 单纯aVR导联ST段抬高,在诊断左主干病变的敏感性为85.5%,特异性47.1%,准确率62.5%;而aVR及V1导联ST段均抬高,且STaVR/STV1＞1时,在诊断左主干病变的敏感性为82.1%,特异性83.8%,准确率83.3%.结论 在运动试验中aVR和V1导联ST段抬高(STaVR/STV1＞1),对左主干病变有较高的预测价值.     

急性心肌梗死时体表心电图预测左主干闭塞的临床意义

目的:分析急性冠状动脉左主干(LM)闭塞的常规心电图(ECG)表现,总结其ECG特点.方法:15例急性心肌梗死(AMI)患者经冠状动脉造影证实为急性LM闭塞(LM组),回顾性分析其急诊ECG表现.并选取同时期30例左前降支(LAD)近段闭塞的AMI患者(LAD组),比较2组造影前的急诊ECG表现,以求总结急性LM闭塞的常规ECG特点.结果:LM组心率快于LAD组,心律失常发生率2组差异无统计学意义.LM组中13例患者存在aVR导联ST段抬高(≥0.05 mV),发生率明显高于LAD组(分别为86.7%和36.7%,P＜0.01),同时LM组aVR导联ST段抬高幅度亦明显大于LAD组.而LM组胸前导联V1～3的ST段抬高程度则明显低于LAD组.aVR导联ST段抬高＞0.05 mV诊断急性LM闭塞的敏感性为90%,特异性为63.3%.如果同时再满足V1～3导联ST段抬高程度＜0.5 mV,其诊断急性LM闭塞的敏感性为90%,特异性达到86.7%.结论:aVR导联ST段抬高≥0.05 mV,同时伴有V1～3导联ST段抬高不明显、甚至压低是急性LM闭塞区别于LAD闭塞的ECG特点,结合临床表现,分析ECG特点可能有助于造影前预测此类患者和进行风险评价.     

aVR导联ST段抬高对阵发性室上性心动过速的鉴别价值

目的探讨aVR导联ST段抬高及其持续时间对阵发性室上性心动过速（PSVT）的鉴别价值。方法126例行射频消融治疗成功的PSVT患者，其中房室折返性心动过速（AVRT）65例，房室结折返性心动过速（AVNRT）61例。分析其aVR导联ST段抬高幅度及持续时间。结果65例AVRT中aVR导联ST抬高且持续时间≥0．08s有46例，61例AVNRT中有13例，诊断AVRT的敏感性、特异性及阳性预测值分别为70．8％，78．7％，78．0％；46例aVR导联ST段抬高的AVRT中左侧旁道占38例，诊断左侧旁道的敏感性、特异性及阳性预测值分别为79．2％，52．9％，82．6％。结论aVR导联ST段抬高及其持续时间有助于鉴别阵发性室上性心动过速，且其多发生于左侧旁道。     

左主干闭塞所致急性心肌梗死的心电图特点

目的分析急性左主干(LM)闭塞的常规心电图(ECG)表现,总结其ECG特点。方法1999年1月至2004年8月,10例急性心肌梗死(AMI)患者经急诊冠状动脉造影证实为急性LM闭塞(LM组),回顾性分析其急诊ECG表现。并选取同时期30例经急诊造影证实为左前降支(LAD)近段闭塞的AMI患者(LAD组),比较两组造影前的急诊ECG表现,以求总结急性LM闭塞的常规ECG特点。结果LM组心率快于LAD组,在心律失常发生率方面两组差异无统计学意义。LM组中9例患者存在aVR导联ST段抬高(≥0·05mV),发生率明显高于LAD组(分别为90%和36·7%,P=0·002),同时LM组aVR导联ST段抬高幅度亦明显大于LAD组。而LM组胸前导联V1-3的ST段抬高程度则明显低于LAD组。aVR导联ST段抬高>0·05mV诊断急性LM闭塞的敏感性为90%,特异性为63·3%。如果同时再满足V1 V2 V3导联ST段抬高程度<0·5mV,其诊断急性LM闭塞的敏感性为90%,特异性达到86·7%。结论aVR导联ST段抬高>0·05mV,同时伴有V1~V3导联ST段抬高不明显、甚至压低是急性LM闭塞区别于LAD闭塞的ECG特点,结合临床表现,分析ECG特点可能有助于造影术前预测此类患者和风险评价。     

An early and simple predictor of severe left main and/or three-vessel disease in patients with non-ST-segment elevation acute coronary syndrome

Clopidogrel should be initiated as soon as possible in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) except those who urgently require coronary artery bypass grafting (CABG). The present study assessed the ability to predict severe left main coronary artery and/or 3-vessel disease (LM/3VD) that would most likely require urgent CABG based on only clinical factors on admission in 572 patients with NSTE-ACS undergoing coronary angiography. Severe LM/3VD was defined as ≥75% stenosis of LM and/or 3VD with ≥90% stenosis in ≥2 proximal lesions of the left anterior descending coronary artery and other major epicardial arteries. Patients were divided into the 3 groups according to angiographic findings: no LM/3VD (n = 460), LM/3VD but not severe LM/3VD (n = 57), and severe LM/3VD (n = 55). Severe LM/3VD was associated with a higher rate of urgent CABG compared to no LM/3VD and LM/3VD but not severe LM/3VD (46%, 2%, and 2%, p <0.001). On multivariate analysis, degree of ST-segment elevation in lead aVR was the strongest predictor of severe LM/3VD (odds ratio 29.1, p <0.001), followed by positive troponin T level (odds ratio 1.27, p = 0.044). ST-segment elevation ≥1.0 mm in lead aVR best identified severe LM/3VD with 80% sensitivity, 93% specificity, 56% positive predictive value, and 98% negative predictive value. In conclusion, ST-segment elevation ≥1.0 mm in lead aVR on admission electrocardiogram is highly suggestive of severe LM/3VD in patients with NSTE-ACS. Selected patients with this finding might benefit from promptly undergoing angiography, withholding clopidogrel to allow early CABG.     

Predictors of left main or three-vessel disease in patients who have acute coronary syndromes with non-ST-segment elevation

To identify an early, simple, noninvasive predictor of left main (LM) or 3-vessel disease (3-VD), we retrospectively studied clinical variables on admission in 310 patients with acute coronary syndromes with non-ST-segment elevation. Univariate analysis indicated that many factors were related to LM/3-VD. Multivariate analysis showed that ST-segment elevation in lead aVR of >/=0.5 mm was the strongest predictor of LM/3-VD, followed by positive troponin T (odds ratio 19.7, p <0.001, and odds ratio 3.08, p = 0.048, respectively). ST-segment elevation in lead aVR of >/=0.5 mm and positive troponin T identified LM/3-VD with sensitivities of 78% and 62%, specificities of 86% and 59%, positive predictive values of 57% and 26%, and negative predictive values of 95% and 87%, respectively (p <0.05). Our findings suggest that in patients with non-ST-segment elevation acute coronary syndromes, ST-segment elevation in lead aVR of >/=0.5 mm and positive troponin T on admission (especially the former) are useful predictors of LM/3-VD.     

aVR ST段抬高对急性冠状动脉综合征患者罪犯病变的预测价值

目的 探讨aVR ST段抬高对非ST段抬高性急性冠状动脉综合征患者罪犯病变的预测价值.方法 选择因非ST段抬高性急性冠状动脉综合征入院的患者213例,根据aVR ST段分为抬高组和不抬高组,分析心电图与冠状动脉造影结果及冠状动脉病变范围及狭窄程度（以Gensini积分表示）的关系.结果 抬高组Gensini积分（58.16±43.85）高于不抬高组（23.53±26.80）,差异有统计学意义（P＜0.05）.而ST段抬高的3个亚组（抬高＜0.10mV、0.10～0.15mV、＞0.15mV）Gensini积分差异均无统计学意义（均P ＞0.05）.aVR ST段抬高0.5mV以上对左主干病变的敏感度、特异度、阳性预测值、阴性预测值分别为77.8%、59.5%、34.0%、90.9%;对三支病变分别为82.1%、67.1%、53.4%、89.1%;对左主干合并三支病变分别为88.5%、57.2%、22.3%、97.3%.结论 aVR ST段抬高者病变较重,但抬高幅度并不能预测狭窄程度.aVR ST段抬高是急性冠状动脉综合征左主干和（或）三支病变较强的预测因子.     

STaVR抬高对急性冠状动脉综合征预后评估的价值

目的探讨心电图STaVR抬高对急性冠状动脉综合征预后评估的价值。方法回顾性分析68例急性冠状动脉综合征患者的心电图和冠状动脉造影资料、临床资料。根据STaVR抬高是否≥0.05mV分为抬高组（n=23）和非抬高组（n=45）。结果病变血管涉及左主干和左前降支近段的分别为抬高组13例（56.5％）和非抬高组1例（2.2％）,病变范围为多支病变的分别为9例（39.1％）和8例（17．8％）,发生心脏事件分别为7例（30.4％）和4例（8.9％）,两组差异均有非常显著性意义（P〈0．01）。结论急性冠状动脉综合征患者STaVR抬高提示左主干和左前降支近段病变、多支病变的可能,对判断预后有参考价值。     

aVR导联ST段回落对非ST段抬高型急性冠脉综合征患者短期预后的评估价值

目的探讨aVR导联ST段抬高回落在非ST段抬高型急性冠脉综合征（NSTE-ACS）患者短期预后中的评估价值。方法纳入NSTE-ACS aVR导联抬高的患者45例;根据入院6h后aVR导联ST段是否回落分为ST段回落组（n=20）与非ST段回落组（n=25）;分析入选患者一般临床资料、心电图、冠状动脉造影结果,并对不良心脏事件的危险因素进行Logistic回归分析。结果 aVR导联ST段无回落组左主干＋三支血管病变率、30d内再发心肌梗死率、急诊PCI及冠脉旁路移植术比例均高于ST段回落组患者,具有统计学差异（P〈0.05）。Logistic回归分析显示,aVR导联ST段无回落是入院后30d内不良心脏事件（死亡、心肌梗死及行血运重建术）独立预测因子（OR=18.54,95%CI：3.57～96.1,P〈0.001）。结论 aVR导联ST段抬高无回落的NSTE-ACS患者其预后差于ST段抬高回落者,aVR导联ST段无回落是NSTE-ACS不良心血管事件的独立预测因子。     

Combined prognostic utility of ST segment in lead aVR and troponin T on admission in non-ST-segment elevation acute coronary syndromes

Many studies have shown that ST-segment depression is a strong predictor of poor outcomes in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs); however, lead aVR was not considered in these studies. The present study examined the prognostic usefulness of the 12-lead electrocardiogram in combination with biochemical markers in 333 patients with NSTE-ACS. ST-segment deviation of > or =0.5 mm was considered clinically significant. Coronary angiography was performed a median of 3 days after admission in all patients. The primary end point was the composite of death, myocardial infarction, and urgent revascularization at 90 days. ST-segment elevation in lead aVR (odds ratio 13.8, 95% confidence interval 1.43 to 100.9, p = 0.03) and increased troponin T (odds ratio 7.9, 95% confidence interval 1.22 to 123.8, p = 0.04) were the only independent predictors of restricted events (death or myocardial infarction) at 90 days. ST-segment elevation in lead aVR (odds ratio 12.8, 95% confidence interval 4.80 to 33.9, p < 0.0001) and increased troponin T (odds ratio 2.03, 95% confidence interval 1.20 to 4.29, p = 0.04) were also the only independent predictors of adverse events (death, myocardial infarction, or urgent revascularization) at 90 days. When ST-segment status in lead aVR was combined with troponin T, patients with ST-segment elevation in lead aVR and increased troponin T had the highest rates of left main or 3-vessel coronary disease (62%) and 90-day adverse outcomes (47%). In conclusion, our findings suggest that ST-segment status in lead aVR combined with troponin T on admission is a simple and useful clinical tool for early risk stratification in patients with NSTE-ACS.     

Prognostic value of positive T wave in lead aVR in patients with non‐ST segment myocardial infarction

Background

Lead aVR provides prognostic information in various settings in patients with ischemia. We aim to investigate the role of a positive T wave in lead aVR in non‐ST segment myocardial infarction (NSTEMI).

Methods

In a prospective cohort study, we included 400 patients with NSTEMI. Presentation electrocardiogram (ECG) was investigated for presence of a positive T wave as well as ST segment elevation (STE) in aVR and study variables were compared. Predictors of primary outcome defined as hospital major adverse cardiovascular events (MACE) and secondary outcome, defined as three‐vessel coronary disease and/or left main coronary artery stenosis (3VD/LMCA) stenosis in angiography, were determined in multivariate logistic regression analysis.

Results

Patients with a positive T wave in aVR were significantly older and were more likely to be female. Left ventricular ejection fraction was significantly lower in patients of positive T group. Positive T group was more likely to have 3VD/LMCA stenosis (58.3% vs. 19.8%, p < .001). The prevalence of a positive T wave in aVR was significantly higher in MACE group (54.9 % vs. 24.8%, p < .001). However, in multivariate analysis, it was not an independent predictor of MACE (OR: 1.083 95% CI: [0.496–2.365], p: .841). Though, it was independently associated with presence of 3VD/LMCA stenosis (OR: 3.747 95% CI: [2.058–6.822], p < .001).

Conclusion

Though positive T wave in lead aVR was more common in patients with MACE; it was not an independent predictor. Additionally, a positive T wave in aVR was an independent predictor of 3VD/LMCA stenosis in NSTEMI.