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Kokyu to Junkan Volume 44, Issue 9 （September 1996）

呼吸と循環 44巻9号（1996年9月発行）

Japanese English

研究

心筋梗塞急性期ST偏位による梗塞責任枝判定規準の妥当性—前向き調査 The Diagnostic Criteria of Infarct-related Coronary Arteries by Electrocardiographic ST-segment Deviations in the Acute Stage of Myocardial Infarction:Prospective study 末綱竜士 ¹ , 斎藤靖浩 ¹ , 沢山俊民 ¹ , 鼠尾祥三 ¹ , 寒川昌信 ¹ , 河原洋介 ¹ , 井上省三 ¹ , 田中淳二 ¹ , 田村敬二 ¹ , 加藤武彦 ¹ , 神山憲王 ¹ , 江幡淳 ¹ , 長谷川浩一 ² Ryoji Suetsuna ¹ , Yasuhiro Saito ¹ , Toshitami Sawayama ¹ , Shoso Nezuo ¹ , Masanobu Samukawa ¹ , Yousuke Kawahara ¹ , Shozo Inoue ¹ , Junji Tanaka ¹ , Keiji Tamura ¹ , Takehiko Katoh ¹ , Norio Kamiyama ¹ , Jun Ebata ¹ , Kouichi Hasegawa ² ¹川崎医科大学内科循環器部門 ²はせ川内科循環器科 ¹Division of Cardiology, Department of Medicine, Kawasaki Medical School ²Hasegawa Clinic キーワード： 12誘導心電図 , 急性心筋梗塞 , 梗塞責任冠動脈 , standard 12-lead ECG , acute myocardial infarction , infarct related artery Keyword: 12誘導心電図 , 急性心筋梗塞 , 梗塞責任冠動脈 , standard 12-lead ECG , acute myocardial infarction , infarct related artery pp.971-976

発行日 1996年9月15日 Published Date 1996/9/15

DOI https://doi.org/10.11477/mf.1404901334

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Abstract 文献概要
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　以前当教室の長谷川が発表したAMIのST偏位と梗塞責任枝（IRA）との関連を前向き調査するため，1990年から5年間に入院したAMI中IRAがRCAもしくはLCXであった36例につき“長谷川lの規準”の妥当性を検討．①『aV_L；ST上昇＋II,III,aV_F；ST下降』ならばLCX seg llor 12がIRA，②『II,III,aV_F；ST上昇』ならばRCA or LCXseg 13がIRA，③『II,III,aV_F；ST上昇＋V₁；ST上昇』ならばRCA seg1がIRAという各規準はいずれも有意な指標であった．一方，II,III,aV_F；ST上昇を認めた場合，IRAがRCAかLCX seg 13かの鑑別は④『同時にV₆のST上昇を伴うかIのST下降を欠けば』LCX seg 13がIRAという規準は有意でなかった．しかし，II,III,aV_FのST偏位にかかわらず『V₆；ST上昇』に着目すればLCXがIRAと判別できた．⑤『V₃：ST下降／aV_F；ST上昇比が有意に大』ならばLCX seg 13がIRAとした規準で，RCAとの判別の基準値を求めるとこの比が0.9以上ならばLCX seg 13がIRAであった．“長谷川の規準”はAMIにおけるIRAの推定に有用なことが裏づけられた．

To investigate the diagnostic criteria for infarct-related coronary arteries (IRA) by electrocardiogra-phic ST-segment deviations in the acute stage of myocardial infarction (AMI), we studied, prospec-tively, 36 patients classified by means of “Hasegawa's criteria”. There were twenty-one patients with rightcoronary artery (RCA), and 15 patients with left circumflex artery (LCX) occlusions. The following results were obtained. ＜criteria 1＞ ; when there was ST segment elevation in lead aVL associated with ST depression in leads II. III. aV_F caused by LCX segment (seg)11 or seg12 occlusion, the sensitivity (Sens.) and specificity (Spcf.) were 87.5%. 92.9%, respectively. ＜criteria 2＞ ; When there was ST elevation in leads II, III, aV_F caused by RCA or LCX seg13 occlusion, the Sens. and Spcf. were 92.9%, 87.5%, respectively. ＜criteria 3＞ ; When there was ST elevation in leads II, III aV_F associated with V₁, caused by RCA segl occlu-sion. the Sens. and Spcf. were 40.0%. 100%, respectively. ＜criteria 4＞ ; When there was differential diagnosis of RCA and LCX seg13 occlusion due to ST elevation in leads II, III, aV_F, and when there was ST elevation in lead V₆ and/or lack of ST depression in lead I cause by LCX seg13 occlusion, the Sens. and Spcf. were 40.0%, 81.0%, respectively. When the presence of ST elevation in lead V₆ was taken into account, RCA could he differentiated from LCX seg13 occlusion. In other words, if there is ST segment elevation in lead V₆, IRA is LCX. The Sens. and Spcf. were 46.7%, 90.5%, respec-tively. ＜criteria 5＞ ; When there was differential diag-nosis of RCA and LCX seg13 occlusion due to ST elevation in leads II, III, aV_F, the ST depression in lead V₃/ST elevation in lead aV_F (V₃ ; ST ↓ /aV_F ; ST↑ ) ratio was significantly larger in LCX seg13. We demon-strated that the most beneficial ratio was 0.9. In other words, the V₃ ; ST ↓ /aV_F ; ST ↑ ratio≧0.9 means LCX seg13 occlusion. The Sens. and Spcf. were 75.0%, 88.2%, respectively. The result of this study was that these ECG criteria (“Hasegawa's criteria”) proved to be useful for diagnosis of IRA in AMI.