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Kokyu to Junkan Volume 46, Issue 1 （January 1998）

呼吸と循環 46巻1号（1998年1月発行）

Japanese English

研究

心電図V₆ 誘導におけるinitial q消失の意義—陳旧性心筋梗塞，左前下行枝病変例での検討 Significance of lnitial q Wave Disappearance in V₆ Lead in Patients with Old Myocardial lnfarction 落合久夫 ¹ , 上野惇 ¹ , 高橋延勝 ¹ , 三谷勇雄 ¹ , 石上友章 ¹ , 芦野和博 ¹ , 住田晋一 ¹ , 南澤康介 ¹ , 石井當男 ¹ Hisao Ochiai ¹ , Jun Ueno ¹ , Nobukatu Takahashi ¹ , Isao Mitani ¹ , Tomoaki Ishigami ¹ , Kazuhiro Ashino ¹ , Sinnichi Sumita ¹ , Kousuke Minamizawa ¹ , Masao ishii ¹ ¹横浜市立大学医学部第2内科 ¹Second Department of Internal Medicine, Yokohama City University School of Medicine キーワード：初期q波 , 心筋梗塞 , 心電図 , initial q wave , old myocardial infarction , electrocardiography Keyword: 初期q波 , 心筋梗塞 , 心電図 , initial q wave , old myocardial infarction , electrocardiography pp.83-87

発行日 1998年1月15日 Published Date 1998/1/15

DOI https://doi.org/10.11477/mf.1404901629

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　純粋な中隔梗塞で心電図V₆誘導のinitial q消失が報告されている．そこで，V₆のini—tial qは前壁中隔梗塞で消失し，梗塞の側壁進展により再び異常Q波として出現するか，心電図と²⁰¹T1心筋SPECTにより検討した．対象は左冠動脈＃6，＃7が責任病変の陳旧性心筋梗塞27例（平均58歳）で，V₆の所見よりinitial q（＋）群9例，initial q（−）群14例，abnormal Q群4例の3群に分類した．initial q（＋）群は，non Q梗塞4例と，側壁に進展した²⁰¹Tl欠損が重症のQ梗塞5例で，前者は中隔障害が軽度でqが消失せず，後者のqは不完全な異常Q波の可能性が考えられた．V₁，V₂の異常Q波はinitial q（−）群に多く認めた．以上より，initial qは前壁中隔梗塞で消失し，側壁進展で再び異常Q波となることが示唆された．

Electrocardiography has been used as a standard method for diagnosing myocardial infarction (MI) in clinical practice, but significance of an initial q wave in V₆, lead remains to be known. To evaluate the diagnos-tic implication of initial q wave disappearance in V₆ lead, 12-lead electrocardiography and T1-201 scintigra-phy were performed in 27 patients (25 males and 2 females, mean age 58 years) with an infarcted proximal or middle left anterior descending artery. Of these sub-jects, initial q waves in V₆ lead were retained in 9, lost in 14, and abnormal Q waves were found in 4. There were no significant differences in the extent of perfusion defect among the three groups. In the group retaining initial q waves, the subjects were divided into two subgroups according to abnormal Q waves : i. e., either 4 non-Q wave MI, or 5 Q wave MI. A significant difference existed in the severity of perfusion defect between the two subgroups (non-Q MI 0.31 ±0.32 vs Q MI 0.78 ± 0.52, p =0.01). All patients with Q MI in this subgroup had abnormal Q waves in I/aV_L leads, suggest-ing that their initial q waves in V₆ lead don't derive from septa] q waves but from incomplete abnormal Q waves. Between the groups retaining and losing initial q waves, the prevalence of abnormal Q waves in I/aV_L lead were more (56% vs 7%, p =0.01) and those in V₁/V₂ lead were less (33%vs 86%, p = 0.01) in the former than in the latter. In the group having abnormal Q waves in V₆ lead, there were 3 broad anterior MI and 1 inferior MI with superdominant left anterior descending artery. Our findings suggest that an initial q waves in V₆ lead are retained in mild non-Q MI, disappear in localized anter-oseptal MI, and appear again as an abnormal Q wave in broad anterior MI.