USEFULNESS OF A 3RD HOLTER LEAD FOR DETECTION OF MYOCARDIAL-ISCHEMIA
USEFULNESS OF A 3RD HOLTER LEAD FOR DETECTION OF MYOCARDIAL-ISCHEMIA
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DOI：
10.1016/0002-9149(94)90551-7
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发表时间：
1994-12-15
影响因子：
2.8
通讯作者：
MASERI, A
中科院分区：
文献类型：
--
作者：
LANZA, GA;MASCELLANTI, M;MASERI, A
双通道动态心电图（ECG）监测是检测冠心病患者短暂心肌缺血的有效方法。然而，仅监测2个导联可能无法检测到大量缺血发作。在这项研究中，通过在223例确诊或疑似冠心病患者（年龄63 ± 10岁）的运动试验中同时记录12导联心电图和3通道动态心电图，评价了第三个双极胸导联的额外诊断价值。在动态心电图上监测导联CM（5）、CM（3）和下导联（Y-改良或CMf）。在98例（44%）患者中检测到标准心电图上的诊断性ST段压低，其中94例（96%）患者在动态心电图上也有诊断性ST段改变。另外2例患者仅在动态心电图上出现ST段压低（均为CM（5）导联）。标准和动态心电图导联检测到的最大ST段压低和缺血持续时间在两种类型的心电图监测检测到ST段变化的94例患者中相似。CM是检测心肌缺血敏感性最高的单导联（89%）。将CM（3）加到CM（5）上可将灵敏度提高到91%，将下壁导联加到CM（5）上可将灵敏度提高到94%，特别是提高了对孤立下壁心肌缺血的检测。所有3个动态ECG导联的组合具有96%的灵敏度，与2个导联的最佳组合相比仅提高2%（即，CM（5）+/-下电极导线）。因此，这些数据表明，在动态ECG设备中添加第三个双极胸导联对改善一过性ST段压低检测的临床相关性有限。他们还指出，监测下电极导线可能会显着改善孤立的下壁缺血的检测。
Two-channel ambulatory electrocardiographic (ECG) monitoring is a useful method for detecting transient myocardial ischemia in patients with coronary artery disease. However, the monitoring of only 2 leads may fail to detect a significant number of ischemic episodes. In this study, the additional diagnostic value of a third bipolar chest lead was evaluated by recording a simultaneous 12-lead electrocardiogram and a 3-channel ambulatory electrocardiogram during exercise testing in 223 patients (aged 63 +/- 10 years) with proved or suspected coronary disease. Leads CM(5), CM(3), and an inferior lead (Y-modified or CMf) were monitored on the ambulatory electrocardiogram. Diagnostic ST-segment depression on the standard electrocardiogram was detected in 98 patients (44%), 94 (96%) of whom also had diagnostic ST-segment changes on the ambulatory electrocardiogram. Two additional patients had ST-segment depression only on the ambulatory electrocardiogram (both in lead CM(5)). Maximal ST-segment depression and duration of ischemia detected on standard and ambulatory ECG leads were similar in the 94 patients in whom ST-segment changes were detected on both types of ECG monitoring. CM, was the single lead with the highest sensitivity (89%) in detecting myocardial ischemia. The addition of CM(3) to CM(5) increased sensitivity to 91%, and the addition of an inferior lead to CM(5) increased sensitivity to 94%, particularly improving the detection of isolated inferior myocardial ischemia. The combination of all 3 ambulatory ECG leads had a sensitivity of 96%, an improvement of only 2% compared with the best combination of 2 leads (i.e., CM(5) +/- inferior lead). Thus, these data indicate that the addition of a third bipolar chest lead to ambulatory ECG devices has limited clinical relevance for improving the detection of transient ST-segment depression. They also indicate that the monitoring of an inferior lead may significantly improve the detection of isolated inferior ischemia.