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Kokyu to Junkan Volume 36, Issue 1 （January 1988）

呼吸と循環 36巻1号（1988年1月発行）

Japanese English

研究

陳旧性前壁梗塞における陰性U波の意義 Significance of negative U waves in previous anterior myocardial infarction 今岡千栄美 ¹ , 兼本成斌 ¹ Chiemi Imaoka ¹ , Nariaki Kanemoto ¹ ¹東海大学医学部第1内科 ¹The First Department of Internal Medicine, School of Medicine, Tokai University pp.87-93

発行日 1988年1月15日 Published Date 1988/1/15

DOI https://doi.org/10.11477/mf.1404205186

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Abstract 文献概要
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　虚血性心疾患，高血圧症，大動脈弁閉鎖不全，心筋症などの諸疾患で陰性U波が出現することは以前から知られている^1〜5）。しかし，U波の成因については，いくつかの仮説が提起されているものの，結論は得られていない^1,5,6）。このため現象面からのアプローチが種々行われており，その成因は必ずしも同一でない可能性が示唆されている^1,5,6）。

　この論文の目的は，発症後1年以内の陳旧性前壁（中隔）梗塞の左側胸部誘導におけるU波の極性を，陽性U波（positive U＝PU），平坦U波（flat U＝FU），陰性U波（negative U＝NU）の3群に分け，おのおのにおける左室機能を比較検討し，NUの臨床的意義を明らかにすることにある。

The purpose of this study is to evaluate the clinical significance of negative U waves in leads V_4~6 in previous anterior myocardial infarction (PAMI). Left ventriculography (LVG) and coronary angio-graphy were obtained from 58 patients (56 men and 2 women ; mean age of 52 years) with PAMI within 1 year after the attack (average 2.7 months). The patients were divided into 3 groups according to the polarity of U waves in leads V_4~6 ; 14 patients with positive U waves (PU), 30 patients with flat U waves (FU) and 14 patients with negative U waves (NU). 15 patients (11 men and 4 women ; mean age of 47 years) were studied as normal controls. Ejection fraction (EF), regional area change (RAC) and radial shortening ratio in 48 segments were examined.

EFs were decreased from normal controls (79.8± 5.1%), PU (74.5±9.9%), FU (59.8±13.1%) to NU (51.1±12.2%) with significant difference. RACs de-monstrated the same tendencies of deterioration in the apical and anterolateral segments. The sensi-tivity of NU showing the apical RAC<15% was 64.3%, specificity was 77.3% and diagnostic accuracy was 94.1%.

As for radial shortening ratio, the patients with PU showed decreased wall motion in segments 19-29 when compared with normal controls. The patients with FU showed decreased wall motion in segments 26-44 when compared with those with PU. The patients with NU showed decreased wall motion in segments 9-11 and 27 when compared with those with FU.

These results suggest that the polarity of U waves correlates significantly with left ventricular function and regional wall motion. Especially negative U waves are a useful indication of large anterior infarct involving apex with decreased left ventricular function and further they could suggest lateral ischemia.