冠動脈病変部位の心電図診断
心筋梗塞患者と冠動脈形成術を施行した狭心症患者を対象に, 心電図所見による責任冠動脈病変の診断能を検討した.前壁誘導の心電図所見による左冠動脈前下行枝の中枢部病変に対する診断能 (感度, 特異度, 陽性予測値) において, I, aVLのST上昇はそれぞれ89, 58, 62%, V1のQS波は62, 83, 72%であった.後壁誘導では, V1のR/S>1は左冠動脈回旋枝の診断に対して50, 90, 50%であった.下壁誘導では, II, III, aVFのST上昇かつaVLの陰性T波は右冠動脈の診断に対して90, 83, 95%であった.右室誘導では, 体表面電位図のV4Rに相当する...
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| Published in | 心電図 Vol. 21; no. 3; pp. 241 - 250 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本不整脈心電学会
2001
日本心電学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1660 1884-2437 |
| DOI | 10.5105/jse.21.241 |
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| Abstract | 心筋梗塞患者と冠動脈形成術を施行した狭心症患者を対象に, 心電図所見による責任冠動脈病変の診断能を検討した.前壁誘導の心電図所見による左冠動脈前下行枝の中枢部病変に対する診断能 (感度, 特異度, 陽性予測値) において, I, aVLのST上昇はそれぞれ89, 58, 62%, V1のQS波は62, 83, 72%であった.後壁誘導では, V1のR/S>1は左冠動脈回旋枝の診断に対して50, 90, 50%であった.下壁誘導では, II, III, aVFのST上昇かつaVLの陰性T波は右冠動脈の診断に対して90, 83, 95%であった.右室誘導では, 体表面電位図のV4Rに相当する誘導のST上昇は, 右室梗塞の診断に対し100, 93, 91%であった.診断能には, 第1対角枝の分岐, 後下行枝の優位性, 正常亜型, 自然再開通の有無が関与すると考えられた.また, 高位側壁の誘導としてV4の1肋間上方, 後壁誘導にはV6の1肋間下方の誘導点を追加することで, 責任冠動脈病変部位の診断精度の上昇の可能性が示唆された. |
|---|---|
| AbstractList | 心筋梗塞患者と冠動脈形成術を施行した狭心症患者を対象に, 心電図所見による責任冠動脈病変の診断能を検討した.前壁誘導の心電図所見による左冠動脈前下行枝の中枢部病変に対する診断能 (感度, 特異度, 陽性予測値) において, I, aVLのST上昇はそれぞれ89, 58, 62%, V1のQS波は62, 83, 72%であった.後壁誘導では, V1のR/S>1は左冠動脈回旋枝の診断に対して50, 90, 50%であった.下壁誘導では, II, III, aVFのST上昇かつaVLの陰性T波は右冠動脈の診断に対して90, 83, 95%であった.右室誘導では, 体表面電位図のV4Rに相当する誘導のST上昇は, 右室梗塞の診断に対し100, 93, 91%であった.診断能には, 第1対角枝の分岐, 後下行枝の優位性, 正常亜型, 自然再開通の有無が関与すると考えられた.また, 高位側壁の誘導としてV4の1肋間上方, 後壁誘導にはV6の1肋間下方の誘導点を追加することで, 責任冠動脈病変部位の診断精度の上昇の可能性が示唆された. 心筋梗塞患者と冠動脈形成術を施行した狭心症患者を対象に, 心電図所見による責任冠動脈病変の診断能を検討した. 前壁誘導の心電図所見による左冠動脈前下行枝の中枢部病変に対する診断能(感度, 特異度, 陽性予測値)において, I, aVLのST上昇はそれぞれ89, 58, 62％, V1のQS波は62, 83, 72％であった. 後壁誘導では, V1のR/S＞1は左冠動脈回旋枝の診断に対して50, 90, 50％であった. 下壁誘導では, II, III, aVFのST上昇かつaVLの陰性T波は右冠動脈の診断に対して90, 83, 95％であった. 右室誘導では, 体表面電位図のV4Rに相当する誘導のST上昇は, 右室梗塞の診断に対し100, 93, 91％であった. 診断能には, 第1対角枝の分岐, 後下行枝の優位性, 正常亜型, 自然再開通の有無が関与すると考えられた. また, 高位側壁の誘導としてV4の1肋間上方, 後壁誘導にはV6の1肋間下方の誘導点を追加することで, 責任冠動脈病変部位の診断精度の上昇の可能性が示唆された. (心電図, 2001；21：241～250) |
| Author | 安保, 泰宏 森, 紳 横井, 博厚 近藤, 貴久 藤原, 稚也 渡邉, 佳彦 古田, 敏也 |
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| References | 4) Blanke H, Cohen M, Schlueter GU, Karsch KR, Rentrop KP: Electrocardiographic and coronary arteriographic correlations during acute myocardial infarction. Am J Cardiol, 1984; 154: 249-255 16) Braat SH, Brugada P, den Dulk K, van Ommen V, Wellens HJJ: Value of lead V4R for recognition of the infarct coronary artery in acute inferior myocardial infarction. Am J Cardiol, 1984; 53: 1538-1541 18) Braat SH, Brugada P, de Zwaan C, Coenegracht JM, Wellens HJJ: Value of electrocardiogram in diagnosing right ventricular involvement in patients with an acute inferior wall myocardial infarction. Br Heart J, 1983; 49: 368-372 7) Bodenheimer MM, Banka VS, Trout RG, Pasdar H, Helfant RH: Correlation of pathologic Q waves on the standard electrocardiogram and the epicardial electrogram of the human heart. Circulation, 1976; 54 213-218 17) Canadell-Riera J, Figuevas J, Valle V, Alvarez A, Gutierrezl L, Cortadellas J, Cinca J, Salas A, Rius J Right ventricular infarction: relationships between ST segment elevation in V4R and hemodynamic, scinitigraphic, and echocardiographic findings in patients with acute inferior wall myocardial infarction. Am Heart J, 1981; 101: 281-287 11) Berry C, Zalewski A, Kovach R, Savage M, Goldberg S: Surface electrocardiogram in the detection of transmural myocardial ischemia during coronary occlusion. Am J Cardiol, 1989; 63: 21-26 10) Myers GB, Klein HA, Stofer BE, Hiratzka T: Normal variations in multiple precordial leads. Am Heart J, 1947; 34: 785-808 8) Huey BL, Bailer GA, Kaiser FDL, Gibson RS: A comprehensive analysis of myocardial infarction due to left circumflex coronary artery occlusion: comparison with infarction due to right coronary artery and left antierior descending artery occlusion. J Am Coil Cardiol, 1988; 12: 1156-1166 2) Roberts WC, Grardin JM: Location of myocardial infarcts: a confusion of terms and definitions. Am J Cardiol, 1978; 42: 868-872 3) Sullivan W, Vlodaver Z, Tuna N, Long L, Edwards JE: Correlation of electrocardiographic and pathologic findings in healed myocardial infarction. Am J Cardiol, 1978; 42: 724-732 1) Savage RM, Wagner GS, Ideker RE, Podolsky SA, Hackel DB: Correlation of postmortemn automatic findings with electrocardiographic changes in patients with myocardial infarction. Circulation, 1977; 55: 279-285 5) Yamada K, Toyama J, Wada M, Sugiyama S, Sugenoya J, Toyoshima H, Mizuno Y, Sotohata I, Kobayashi T, Okajima M: Body surface isopotential mapping in Wolff-Parkinson-White syndrome: Noninvasive method to determine the localization of the accessory atrioventricular pathway. Am Heart J, 1975; 90: 721-734 15) Lepeschkin E: Modern electrocardiography, The Williams & Wilkins Co, Baltimore, 1951; vol 1 13) Coma-Canella I, Lopez-Sendon J, Alcasena S, Garcia C, Gamallo C, Jadraque LM: Electrocardiographic alternations in leads V1 to V3 in the diagnosis of right and left ventricular infarction. Am Heart J, 1986; 112 940-946 12) Mizutani M, Freedman SB, Barns E, Ogasawara S, Bailey BP, Bernstein L: ST monitoring for myocardial ischemia during and after coronary angioplasty. Am J Cardiol, 1990; 66: 389-393 14) Croft CH, Nicod P, Corbett JR, Lewis SE, Huxrey R, Mukharji J, Willerson JT, Rude RE: Detection of acute right ventricular infarction by right precordial electrocardiography. Am J Cardioi, 1982; 50: 421-427 9) Fuchs RM, Achuff SC, Grunwald L, Yin FCP, Griffith LSC: Electrocardiographic localization of coronary artery narrowing: studies during myocardial ischemia and infarction in patients with one-vessel disease. Circulation, 1982; 66: 1168-1176 19) Klein HO, Tordjman T, Ninio R, Sarelli P, Oren V, Lang R, Gefen J, Pauzner C, Segni ED, David D, Kaplinsky E: The early recognition of right ventricular infarction Diagnostic accuracy of the electrocardiographic V4R lead. Circulation, 1983; 67: 558-565 6) Flowers NC, Horan LG, Sohi GS, Hand RC, Johnson JC: New evidence of inferoposterior myocardial infarction on surface potential maps. Am J Cardiol, 1976; 38: 576-581 |
| References_xml | – reference: 11) Berry C, Zalewski A, Kovach R, Savage M, Goldberg S: Surface electrocardiogram in the detection of transmural myocardial ischemia during coronary occlusion. Am J Cardiol, 1989; 63: 21-26 – reference: 14) Croft CH, Nicod P, Corbett JR, Lewis SE, Huxrey R, Mukharji J, Willerson JT, Rude RE: Detection of acute right ventricular infarction by right precordial electrocardiography. Am J Cardioi, 1982; 50: 421-427 – reference: 18) Braat SH, Brugada P, de Zwaan C, Coenegracht JM, Wellens HJJ: Value of electrocardiogram in diagnosing right ventricular involvement in patients with an acute inferior wall myocardial infarction. Br Heart J, 1983; 49: 368-372 – reference: 7) Bodenheimer MM, Banka VS, Trout RG, Pasdar H, Helfant RH: Correlation of pathologic Q waves on the standard electrocardiogram and the epicardial electrogram of the human heart. Circulation, 1976; 54 213-218 – reference: 12) Mizutani M, Freedman SB, Barns E, Ogasawara S, Bailey BP, Bernstein L: ST monitoring for myocardial ischemia during and after coronary angioplasty. Am J Cardiol, 1990; 66: 389-393 – reference: 8) Huey BL, Bailer GA, Kaiser FDL, Gibson RS: A comprehensive analysis of myocardial infarction due to left circumflex coronary artery occlusion: comparison with infarction due to right coronary artery and left antierior descending artery occlusion. J Am Coil Cardiol, 1988; 12: 1156-1166 – reference: 2) Roberts WC, Grardin JM: Location of myocardial infarcts: a confusion of terms and definitions. Am J Cardiol, 1978; 42: 868-872 – reference: 6) Flowers NC, Horan LG, Sohi GS, Hand RC, Johnson JC: New evidence of inferoposterior myocardial infarction on surface potential maps. Am J Cardiol, 1976; 38: 576-581 – reference: 1) Savage RM, Wagner GS, Ideker RE, Podolsky SA, Hackel DB: Correlation of postmortemn automatic findings with electrocardiographic changes in patients with myocardial infarction. Circulation, 1977; 55: 279-285 – reference: 13) Coma-Canella I, Lopez-Sendon J, Alcasena S, Garcia C, Gamallo C, Jadraque LM: Electrocardiographic alternations in leads V1 to V3 in the diagnosis of right and left ventricular infarction. Am Heart J, 1986; 112 940-946 – reference: 4) Blanke H, Cohen M, Schlueter GU, Karsch KR, Rentrop KP: Electrocardiographic and coronary arteriographic correlations during acute myocardial infarction. Am J Cardiol, 1984; 154: 249-255 – reference: 17) Canadell-Riera J, Figuevas J, Valle V, Alvarez A, Gutierrezl L, Cortadellas J, Cinca J, Salas A, Rius J Right ventricular infarction: relationships between ST segment elevation in V4R and hemodynamic, scinitigraphic, and echocardiographic findings in patients with acute inferior wall myocardial infarction. Am Heart J, 1981; 101: 281-287 – reference: 19) Klein HO, Tordjman T, Ninio R, Sarelli P, Oren V, Lang R, Gefen J, Pauzner C, Segni ED, David D, Kaplinsky E: The early recognition of right ventricular infarction Diagnostic accuracy of the electrocardiographic V4R lead. Circulation, 1983; 67: 558-565 – reference: 5) Yamada K, Toyama J, Wada M, Sugiyama S, Sugenoya J, Toyoshima H, Mizuno Y, Sotohata I, Kobayashi T, Okajima M: Body surface isopotential mapping in Wolff-Parkinson-White syndrome: Noninvasive method to determine the localization of the accessory atrioventricular pathway. Am Heart J, 1975; 90: 721-734 – reference: 16) Braat SH, Brugada P, den Dulk K, van Ommen V, Wellens HJJ: Value of lead V4R for recognition of the infarct coronary artery in acute inferior myocardial infarction. Am J Cardiol, 1984; 53: 1538-1541 – reference: 3) Sullivan W, Vlodaver Z, Tuna N, Long L, Edwards JE: Correlation of electrocardiographic and pathologic findings in healed myocardial infarction. Am J Cardiol, 1978; 42: 724-732 – reference: 9) Fuchs RM, Achuff SC, Grunwald L, Yin FCP, Griffith LSC: Electrocardiographic localization of coronary artery narrowing: studies during myocardial ischemia and infarction in patients with one-vessel disease. Circulation, 1982; 66: 1168-1176 – reference: 10) Myers GB, Klein HA, Stofer BE, Hiratzka T: Normal variations in multiple precordial leads. Am Heart J, 1947; 34: 785-808 – reference: 15) Lepeschkin E: Modern electrocardiography, The Williams & Wilkins Co, Baltimore, 1951; vol 1 |
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| Snippet | 心筋梗塞患者と冠動脈形成術を施行した狭心症患者を対象に, 心電図所見による責任冠動脈病変の診断能を検討した.前壁誘導の心電図所見による左冠動脈前下行枝の中枢部病... 心筋梗塞患者と冠動脈形成術を施行した狭心症患者を対象に, 心電図所見による責任冠動脈病変の診断能を検討した. 前壁誘導の心電図所見による左冠動脈前下行枝の中枢部病... |
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| SubjectTerms | 体表面電位図 冠動脈形成術 心筋梗塞 標準12誘導心電図 狭心症 |
| Title | 冠動脈病変部位の心電図診断 |
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