aVR导联ST段改变对不同冠脉血管病变的诊断及鉴别诊断意义

doi:10.13308/j.issn.2095-9354.2016.05.006

Abstract
Figure/Table
References
Related Citation (15)

Download: PDF (1154 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract The elevation and depression of lead aVR ST segment in electrocardiogram may result from left main coronary artery(LMCA) or its major branches diseases. However, the risk stratification and clinical prognosis of myocardial ischemia or myocardial infarction due to different vascular lesions are rather different from each other. Therefore, it is important to make diagnosis and differential diagnosis of different coronary artery diseases. The changes of ST segment in lead aVR have important clinical significance, the diagnostic and differential diagnostic values of which are higher than any other single lead or multiple leads. This paper reviews on the diagnostic and differential diagnostic significance of the elevation and depression of lead aVR ST segment for different coronary artery diseases, diagnostic criteria and the latest overseas research progress in recent years.

Key words： electrocardiogram lead aVR left main coronary artery disease 3 vessel disease anterior wall myocardial infarction inferior wall myocardial infarction acute coronary syndrome

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	ZHANG Jian-Yi
	ZHANG Yu-Zhong

Cite this article:

ZHANG Jian-Yi,ZHANG Yu-Zhong. The significance of lead aVR ST segment changes in the diagnosis and differential diagnosis of different coronary artery diseases[J]. JOURNAL OF PRACTICAL ELECTROCARDIOLOGY, 2016, 25(5): 328-333.

URL:

http://zzs.ujs.edu.cn/syxd/EN/10.13308/j.issn.2095-9354.2016.05.006 OR http://zzs.ujs.edu.cn/syxd/EN/Y2016/V25/I5/328

[1] Yamaji H, Iwasaki K, Kusachi S, et al. Prediction of acute left main coronary artery obstruction by 12-lead 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.

[2] 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. 

[3] 张羽中，张建义. aVR导联ST段抬高对冠脉左主干和/或3支血管病变的诊断意义[J]. 实用心电学杂志, 2016, 25(5)：322-327.

[4] Wong SC, Sanborn T, Sleeper LA, et al. Angiographic findings and clinical correlates in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. Should we emergently revascularize occluded coronaries for cardiogenic shock?[J]. J Am Coll Cardiol, 2000, 36 (3 Suppl A)：1077-1083.

[5] Elsman P, van’t Hof AW, Hoorntje JC, et al. Effect of coronary occlusion site on angiographic and clinical outcome in acute myocardial infarction patients treated with early coronary intervention[J]. Am J Cardiol, 2006, 97(8)：1137-1141.

[6] Zeymer U, Vogt A, Zahn R, et al. Predictors of inhospital mortality in 1333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention(PCI); Results of the primary PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhaus rzte (ALKK)[J]. Eur Heart J, 2004, 25(4)：322-328. 

[7] Aygul N, Ozdemir K, Tokac M, et al. Value of lead aVR in predicting acute occlusion of proximal left anterior descending coronary artery and inhospital outcome in STelevation myocardial infarction: an electrocardiographic predictor of poor prognosis[J]. Electrocardiol, 2008, 41(4)：335-341.

[8] Tamura A. Significance of lead aVR in acute coronary syndrome[J]. World J Cardiol, 2014, 6(7): 630-637.

[9] Kühl JT, Berg RM. Utility of lead aVR for identifying the culprit lesion in acute myocardial infarction[J]. Ann Noninvasive Electrocardiol, 2009, 14(3)：219-225.

[10] 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.

[11] 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.

[12] 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. 

[13] 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.

[14] Kosuge M, Uchida K, Imoto K, et al. Prognostic value of STsegment elevation in lead aVR in patients with type A acute aortic dissection[J]. J Am Coll Cardiol, 2015, 65(23)：2570-2571.

[15] Kosuge M, Ebina T, Hibi K, et al. STsegment depression in lead aVR predicts 30day adverse outcomes in patients with inferior acute myocardial infarction[J]. J Am Coll Cardiol, 2016, 67(13)：475-475.

[16] Vales L, Kanei Y, Schweitzer P. Electrocardiographic predictors of culprit artery in acute inferior ST elevation myocardial infarction[J]. J Electrocardiol, 2011, 44(1)：31-35.

[17] Ching S, Ting SM. The forgotten lead：aVR in left main disease[J]. Am J Med, 2015, 128(12)：e11-e13.

[18] 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.

[19] Alherbish A, Westerhout CM, Fu Y, et al. The forgotten lead：does aVR STdeviation add insight into the outcomes of STelevation myocardial infarction patients?[J]. Am Heart J, 2013, 166(2)：333-339.

[20] Kanei Y, Sharma J, Diwan R, et al. STsegment depression in aVR as a predictor of culprit artery and infarct size in acute inferior wall STsegment elevation myocardial infarction[J]. J Electrocardiol, 2010, 43(2)：132-135.