Abstract:Severe coronary artery diseases include acute complete or subtotal occlusion of left main coronary artery(LMCA) and 3vessel disease(3vd). Although the patients with acute complete occlusion of LMCA rarely arrive to hospital alive, the specificity and accuracy rate of ST segment elevation in lead aVR are both above 80%. For the patients with acute subtotal occlusion of LMCA and 3 vd, its diagnostic value is higher than that of any other single lead or multiple ones. The higher the amplitude of ST segment elevation in lead aVR is and the longer the duration is, the more serious the patients condition is. This paper reviews the diagnostic criteria of ST segment elevation in lead aVR, electrophysiological mechanism and overseas research progress.
张羽中, 张建义. aVR导联ST段抬高对冠脉左主干和/或3支血管病变的诊断价值[J]. 实用心电学杂志, 2016, 25(5): 322-327.
ZHANG Yu-Zhong, ZHANG Jian-Yi. Diagnostic value of ST segment elevation in lead aVR for patients with left main coronary artery and (or)3 vessel disease. JOURNAL OF PRACTICAL ELECTROCARDIOLOGY, 2016, 25(5): 322-327.
[1] Rostoff P, Piwowarska W, Gackowski A, et al. Electrocardiographic prediction of acute left main coronary artery occlusion[J]. Am J Emerg Med, 2007, 25(7):852-855.[2] Nikus KC. Acute total occlusion of the left main coronary artery with emphasis on electrocardiographic manifestations[J]. Timely Top Med Cardiovasc Dis, 2007, 11:E22.[3] Nikus KC, Eskola MJ. Electrocardiogram patterns in acute left main coronary artery occlusion[J]. J Electrocardiol, 2008, 41(6):626-629.[4] Tamura A. Significance of lead aVR in acute coronary syndrome[J]. World J Cardiol, 2014, 6(7):630-637.[5] Yip HK, Wu CJ, Chen MC, et al. Effect of primary angioplasty on total or subtotal left main occlusion—analysis of incidence, clinical features, outcomes, and prognostic determinants[J]. Chest, 2001, 120(4):1212-1217.[6] Pourafkari L, Tajlil A, Mahmoudi SS, et al. The value of lead aVR ST segment changes in localizing culprit lesion in acute inferior myocardial infarction and its prognostic impact[J]. Ann Noninvasive Electrocardiol, 2016, 21(4):389-396.[7] Gorgels AP, Engelen DJ, Wellens HJ. Lead aVR, a mostly ignored but very valuable lead in clinical electrocardiography[J]. J Am Coll Cardiol, 2001, 38(5):1355-1356.[8] Yamaji H, Iwasaki K, Kusachi S, et al. Prediction of acute left main coronary artery obstruction by 12lead electrocardiography:ST segment elevation in lead aVR with less ST segment elevation in lead V1[J]. J Am Coll Cardiol, 2001, 38(5):1348-1354.[9] Rostoff P, Piwowarska W, Konduracka E, et al. Value of lead aVR in the detection of significant left main coronary artery stenosis in acute coronary syndrome[J]. Kardiol Pol, 2005, 62(2):128-135.[10] Rostoff P, Piwowarska W. ST segment elevation in lead aVR and coronary artery lesions in patients with acute coronary syndrome[J]. Kardiol Pol, 2006, 64(1):8-14.[11] Makaryus AN. Global electrocardiographic changes accompanying acute presentation of 3 vessel coronary disease[J]. Am J Emerg Med, 2006, 24(3):355-356.[12] Kosuge M, Kimura K, Ishikawa T, et al. Predictors of left main or three vessel disease in patients who have acute coronary syndromes with non-ST-segment elevation[J]. Am J Cardiol, 2005, 95(11):1366-1369.[13] Ching S, Ting SM. The forgotten lead:aVR in left main disease[J]. Am J Med, 2015, 128(12):e11-e13.[14] Kosuge M , Ebina T, Hibi K, et al. An early and simple predictor of severe left main and/or threevessel disease in patients with nonSTsegment elevation acute coronary syndrome[J]. Am J Cardiol, 2011, 107(4):495-500.[15] Taglieri N, Marzocchi A, Saia F, et al. Short and longterm prognostic significance of ST-segment elevation in lead aVR in patients with nonSTsegment elevation acute coronary syndrome[J]. Am J Cardiol, 2011, 108(1):21-28.[16] Kosuge M, Kimura K. Value of ST-segment elevation in lead aVR for predicting severe left main or 3vessel disease[J]. Am J Med, 2016, 129(6):e37.[17] Misumida N, Kobayashi A, Fox JT, et al. Predictive value of STsegment elevation in lead aVR for left main and/or threevessel disease in nonSTsegment elevation myocardial infarction[J]. Ann Noninvasive Electrocardiol, 2016, 21(1):91-97.[18] Ducas R, Ariyarajah V, Philipp R, et al. The presence of ST-in lead aVR predicts significant left main coronary artery stenosis in cardiogenic shock resulting from myocardial infarction:the Manitoba cardiogenic shock registry[J]. Int J Cardiol, 2013, 166(2):465-468.[19] Nabati M, Emadi M, Mollaalipour M, et al. ST-segment elevation in lead aVR in the setting of acute coronary syndrome[J]. Acta Cardiol, 2016, 71(1):47-54.[20] Alherbish A, Westerhout CM, Fu Y, et al. The forgotten lead: does aVR STdeviation add insight into the outcomes of STelevation myocardial infarction patients?[J]. Am Heart J, 2013, 166(2):333-339.[21] Barrabés JA, Figueras J, Moure C, et al. Prognostic value of lead aVR in patients with a first non-ST-segment elevation acute myocardial infarction[J]. Circulation, 2003, 108(7): 814-819.[22] Kosuge M, Ebina T, Hibi K, et al. STsegment elevation resolution in lead aVR:a strong predictor of adverse outcomes in patients with nonSTsegment elevation acute coronary syndrome[J]. Circ J, 2008, 72(7):1047-1053.[23] Hirano T, Tsuchiya K, Nishigaki K, et al. Clinical features of emergency electrocardiography in patients with acute myocardial infarction caused by left main trunk obstruction[J]. Circ J, 2006, 70(5):525-529.[24] 张建义, 张羽中. aVR导联及其特殊位置对冠心病诊断的意义[J]. 实用心电学杂志, 2016, 25(5):317-321,327.[25] Talebi S, Visco F, Pekler G, et al. Diagnostic value of lead aVR in acute coronary syndrome[J]. Am J Emerg Med, 2015, 33(10):1527-1530.