2022 年第 9 期 第 17 卷

无心肌梗死患者运动诱发心电图ST段抬高与冠状动脉狭窄的关系

Relationship between exercise-induced ST-segment elevation and coronary artery stenosis in patients without myocardial infarction

作者：李玉凤1袁超1李岩1王熙1郭雅莲1孙北1张纯燕1周洋1郭成军2吴永全2方冬平2

英文作者：Li Yufeng1 Yuan Chao1 Li Yan1 Wang Xi1 Guo Yalian1 Sun Bei1 Zhang Chunyan1 Zhou Yang1 Guo Chengjun2 Wu Yongquan2 Fang Dongping2

单位：1首都医科大学附属北京安贞医院心电图室，北京100029；2首都医科大学附属北京安贞医院起搏中心二十一病房，北京100029

英文单位：1Electrocardiographic Room Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2the Twenty-first Ward Pacing Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：平板运动试验；心电图；ST段抬高；冠状动脉狭窄

英文关键词：Treadmillexercisetest;Electrocardiogram；ST-segmentelevation;Coronaryarterystenosis

• 摘要：

• 目的 分析无心肌梗死患者平板运动试验（TET）诱发心电图ST段抬高与冠状动脉狭窄的关系。方法  回顾性选取2008年8月至2018年8月在首都医科大学附属北京安贞医院行诊断性TET检查出现ST段抬高并进一步行冠状动脉造影（CAG）检查的无心肌梗死患者22例。分析TET心电图ST段抬高与CAG检查冠状动脉狭窄的关系。结果  22例患者中，1例（4.5%）冠状动脉正常；12例（54.5%）为单支病变，其中9例左前降支狭窄，3例右冠状动脉狭窄；5例（22.7%）为双支病变，其中1例是左前降支+右冠状动脉狭窄，2例左前降支+左回旋支狭窄，2例是左回旋支+右冠状动脉狭窄；4例（18.2%）为多支病变，均为左前降支+左回旋支+右冠状动脉狭窄。22例患者中11例胸导联ST段抬高，CAG显示均有左前降支病变，狭窄程度为50%～90%；8例Ⅱ和/或Ⅲ和/或aVF导联ST段抬高，CAG显示其中6例有右冠状动脉病变，狭窄程度为70%～100%，1例左前降支中段肌桥，对角支70%狭窄，1例只有左回旋支远段20%～30%狭窄；1例V1及aVR导联ST段抬高提示多支病变，CAG显示左前降支中段狭窄80%，对角支狭窄70%，左回旋支近段狭窄60%，钝缘支近段狭窄80%，右冠状动脉远段狭窄99%；1例V1及Ⅲ导联ST段抬高，CAG显示第一对角支近段狭窄40%，左回旋支近段狭窄50%，右冠状动脉开口狭窄90%；1例aVL导联ST段抬高，CAG显示左前降支中段狭窄90%，左回旋支中段狭窄85%。结论 无心肌梗死患者TET诱发心电图ST段抬高多数与冠状动脉狭窄密切相关，需要高度重视。

• Objective  To analyze the relationship between ST-segment elevation induced by treadmill exercise test (TET) and coronary artery stenosis in patients without myocardial infarction. Methods  Totally 22 patients with ST-segment elevation who underwent diagnostic TET and then underwent coronary angiography (CAG) in Beijing Anzhen Hospital, Capital Medical University from August 2008 to August 2018 were retrospectively selected. The relationship between ST-segment elevation induced by TET and coronary artery stenosis in CAG was analyzed. Results  Among the 22 patients, 1 case(4.5%) had normal coronary artery; 12 cases (54.5%) had single vessel disease, including 9 cases of left anterior descending artery stenosis and 3 cases of right coronary artery stenosis; 5 cases (22.7%) were double vessel disease, including 1 case of left anterior descending branch+right coronary artery stenosis, 2 cases of left anterior descending branch+left circumflex branch stenosis, and 2 cases of left circumflex branch+right coronary artery stenosis; 4 cases (18.2%) were multivessel lesions, with left circumflex branch+left circumflex branch+right coronary artery stenosis. Among the 22 patients, 11 cases had ST-segment elevation in the thoracic lead, and CAG showed left anterior descending branch lesions, with a stenosis degree of 50%-90%; in 8 cases with ST-segment elevation in leads Ⅱ and/or Ⅲ and/or aVF, CAG showed that 6 of them had right coronary artery disease, with a stenosis degree of 70%-100%, 1 case had a muscle bridge in the middle of the left anterior descending branch, 70% stenosis in the diagonal branch, and 1 case had only 20%-30% stenosis in the distal segment of the left circumflex branch; one case with ST-segment elevation in leads V1 and aVR was suggested multi vessel disease, and CAG showed 80% stenosis in the middle of the left anterior descending branch, 70% stenosis in the diagonal branch, 60% stenosis in the proximal left circumflex branch, 80% stenosis in the proximal blunt branch, and 99% stenosis in the distal right coronary artery; one case with ST-segment elevation in leads V1 and Ⅲ, CAG showed that the proximal segment of the first diagonal branch was 40%, the proximal segment of the left circumflex branch was 50%, and the opening of the right coronary artery was 90%; one case with ST-segment elevation in aVL lead, CAG showed that the middle segment of left anterior descending branch was narrowed by 90%, and the middle segment of left circumflex branch was narrowed by 85%. Conclusion  ST-segment elevation induced by TET in patients without myocardial infarction is closely related to coronary artery stenosis, which should be paid more attention.