冠脉内心电图对分叉病变中分支心肌缺血的判断价值.docVIP

冠脉内心电图对分叉病变中分支心肌缺血的判断价值 陈亮波，李志樑，傅强.南方医科大学 珠江医院心内科，广东广州510282 摘要 目的 研究冠脉内心电图对分叉病变中分支心肌缺血的判断价值。 方法 65例分叉病变患者，采用Cross-over治疗策略。主支支架植入前，进行冠脉造影和分支血管冠脉内心电图(IC-ECG)检查；主支支架植入后，复查冠脉造影和分支血管冠脉内心电图，对分支血管进一步行FFR检查。结果 主支支架植入后，分支血管明显狭窄，狭窄率达65.1±21.4%。IC-ECG ST段变化≥0.1 mV 20患者中，17例FFR≤0.80。IC-ECG ST段变化﹤0.1mV 45患者中，4例FFR≤0.80。以FFR≤0.80作为判断分分支狭窄病变引起心肌缺血标准，冠脉内心电图变化对分支心肌缺血预测的敏感性81%，特异性93%；阳性预测值85%，阴性预测值91%。结论IC-ECG能有效判断分支狭窄病变是否引起心肌缺血，具有即刻、便捷、不增加患者费用等优点，值得临床推广应用。 关键词 心电描记术 分叉病变 冠状动脉血流储备分数 Intracoronary electrocardiogram evaluation myocardial ischemia of side branch in Bifurcation lesions Chen liangbo ,li zhiliang ,Fu qiang.Department of Cardiology，Zhujiang Hospital，Southern Medical University，Guangzhou 510282，Guangdong，China Abstract objective To evaluation myocardial ischemia of side branch in Bifurcation lesions with Intracoronary electrocardiogram. Methods 65 pations with bifurcation lesions were enrolled in this study, which were performed with cross-over stent techniques. Before main vessels were stented, coronary cardiogram and intracoronary electrocardiogram of branch sides were performed. After main branches were stented, coronary cardiogram and intracoronary electrocardiogram of branch sides were rechecked, and myocardial fractional flow reserve with pressure wire were performed in side branches. Results After main vessels stented, side brachches stenoses were 65.1±21.4% .IC-ECG showed a significant ST segment shift in 20 patients, FFR values were ≤0.80 in 17 patients. While IC-ECG showed a non-significant ST segment shift in 45 patients, FFR values were ≤0.80 only in 4 patients. Sensitivity of IC-ECG for predicting an abnormal FFR value was 81%,specifity 93%,positive and negative accuracies were 85%and 91%, respectively. Conclusions Intracoronary electrocardiogram can assess myocardial ischemia of side branch in Bifurcation lesions instantly and conveniently, and it can’t increase fees. It’s worthy for clinical use. Key words electrocardiogram; bifurcation; myocardial f