Detection of acute right ventricular infarction by right precordial electrocardiography.
Detection of acute right ventricular infarction by right precordial electrocardiography.
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右心前区心电图检测急性右心室梗死。
DOI：
10.1016/0002-9149(82)90305-8
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发表时间：
1982
期刊：
影响因子：
--
通讯作者：
Rude,RE
中科院分区：
文献类型：
--
作者：
Croft,CH;Nicod,P;Corbett,JR;Lewis,SE;Huxley,R;Mukharji,J;Willerson,JT;Rude,RE
在43名受试者中前瞻性评估了至少一个右胸导联（V4 R至V6 R）的S-T段抬高0.1 mV或更高的值在定义右心室心肌梗死中的价值（33名连续的经酶证实的不同类型和位置的梗死患者，4名不稳定型心绞痛患者和6名健康志愿者）。急性心肌梗塞患者分别于发病后18.2 ± 14.3（平均值±标准差）和85.1 ± 18.0小时进行放射性核素心室造影和~（99）m锝焦磷酸亚锡心肌显像。11例患者（A组：9例透壁下壁梗死，1例透壁下外侧梗死和1例透壁前间隔梗死）显示右心前区S-T段抬高，22例患者（B组：透壁下壁梗死6例，透壁后壁梗死2例，透壁下外侧梗死3例，透壁前间隔梗死3例，透壁广泛前壁梗死3例，前壁下梗死4例，未分类梗死1例。右室射血分数A组（0.47 ± 0.11）明显低于B组（0.60 ± 0.12）（P < 0.01）。A组右心室总室壁运动评分为正常值的63.8 ± 15.6%，而B组为94.3 ± 8.5%（p < 0.001）。A组9例（81.8%）和B组1例（4.5%）右心室摄取锝-99 m焦磷酸盐（2+或更高）（p < 0.001）。无不稳定型心绞痛患者和健康志愿者出现右胸导联ST段抬高。V4 R至V6 R导联中的一个或多个导联S-T段抬高0.1 mV或更高，在识别急性右心室梗死时具有高度敏感性（90%）和特异性（91%）。
The value of 0.1 mV or greater of S-T segment elevation in at least one right precordial lead (V4R to V6R) in defining right ventricular myocardial infarction was assessed prospectively in 43 subjects (33 consecutive patients with enzymatically confirmed infarction of varying type and location, 4 patients with unstable angina and 6 healthy volunteers). Patients with acute myocardial infarction were studied with radionuclide ventriculography and technetium-99m stannous pyrophosphate myocardial scintigraphy 18.2 ± 14.3 (mean ± standard deviation) and 85.1 ± 18.0 hours after the onset of symptoms, respectively. Eleven patients (Group A: 9 patients with transmural inferior infarction, 1 with transmural inferolateral infarction and 1 with transmural anteroseptal infarction) demonstrated right precordial S-T segment elevation and 22 patients (Group B: 6 patients with transmural inferior infarction, 2 with transmural posterior infarction, 3 with transmural inferolateral infarction, 3 with transmural anteroseptal infarction, 3 with transmural extensive anterior infarction, 4 with subendocardial anterior infarction and 1 with unclassified infarction) did not. Right ventricular ejection fraction was significantly lower in Group A (0.47 ± 0.11) than in Group B (0.60 ± 0.12) (p < 0.01). Right ventricular total wall motion score was 63.8 ± 15.6 percent of normal in Group A versus 94.3 ± 8.5 percent in Group B (p < 0.001). Technetium-99m pyrophosphate uptake (2+ or greater) over the right ventricle occurred in nine patients (81.8 percent) in Group A and in one patient (4.5 percent) in Group B (p < 0.001). No patient with unstable angina and no healthy volunteer had S-T segment elevation in a right precordial lead. S-T segment elevation of 0.1 mV or greater in one or more of leads V4R to V6R is both highly sensitive (90 percent) and specific (91 percent) in identifying acute right ventricular infarction.