Original Articles Korean Circulation J 1998;2810:1707-1716 급성심근경색증에서경색심근의관류정도와 12 유도 심전도상 R 파, ST 절, QRS 평점과의관계 안정천 김수미 황교승 이은미 송우혁 임도선박창규 김영훈 서홍석 심완주 오동주 노영무 Significance of ST Segment, R Wave, Q Wave and QRS Score for Assessing Myocardial Perfusion in Acute Myocardial Infarction Jeong Cheon Ahn, MD, Soo Mi Kim, MD, Kyo Seung Hwang, MD, Eun Mi Lee, MD, Woo Hyuk Song, MD, Chang Gyu Park, MD, Young Hoonm Kim, MD, Hong Seog Seo, MD, Wan Joo Shim, MD, Dong Joo Oh, MD and Young Moo Ro, M.D. Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea ABSTRACT Background and ObjectivesThe restoration of infarct-related coronary artery IRA patency in acute myocardial infarction AMI linked to a significant improvement in survival. Because of microvascular and cellular injury, patent IRA does not always represent successful reperfusion. With progress of myocardial ischemia, standard 12 lead ECG shows evolutional changes of ST-segment, R wave and Q wave. But their relations to myocardial perfusion were uncertain. MethodsTotal 41 patients of the first anterior wall AMI were enrolled and serial ECGs were taken to measure sum of ST-segment elevation ST, sum of Q wave Q, sum of R wave R, and QRS score QRSs proposed by Selvester in each patients before thrombolytic therapy i, after coronary angiography at 90 minutes of thrombolytic therapy a, and before discharge d. Myocardial contrast echocardiography was performed within 10 days of AMI to estimate opacification score OS and opacification index OI in segments of LAD territory. We investigate the relation between evolution of ECG changes and perfusion status of infarcted myocardium. Results1 There was no relation between OI and ST, but R and QRSs showed significant relation with OI before discharge r0.59, 0.33, p0.05, respectively, post thrombolytic therapy r0.51, 0.61, p0.05, and baseline ECG r0.53, 0.51, p0.05. 2 The number of segments with OS 0.5 showed no singificant relation to the degree of ST and Q, but number of segments with OS 0 showed singinficant relation to that of R and QRSs r of Ri, Ra, Rd vs number of segments with OS 00.59, 0.66, 0.43, p0.05, QRSi, QRSa, QRSd vs number of segments with OS 00.58, 0.58, 0.57, p0.05. ConclusionThese findings suggest that the ECG changes of R wave and QRS scores could be useful markers of perfusion state in thrombolytic era. Korean Circulation J 1998;2810:1707-1716 KEY WORDSAcute myocardial infarction Myocardial perfusion ECG Myocardial contrast-echocardiography. 1707
서론 1708 대상및방법 연구대상 관동맥조영술및심근조영심초음파도검사의시행 Korean Circulation J 1998;2810:1707-1716
심전도검사 통계처리 Fig. 1. Observed segments in LAD territory. Table 1. QRS scoring system in Anterior wall acute myocardial infarction V12 Any Q **1 V43 Q20ms 1 R/S0.5 2 Q or S1.8mV 1 R/Q0.5 2 R/S1 1 V21 Any Q 1 R/Q1 1 R0.7mV 1 R10ms 1 Notched R 1 R0.1mV 1 V53 Q30ms 1 R/S1 2 RRV1mV 1 R/Q1 2 R/S2 1 V31 Any Q 1 R/Q2 1 R0.7mV 1 R20ms 1 Notched R 1 R0.2mV 1 V63 Q30ms1 R/S1 2 R/Q1 2 R/S3 1 R/Q3 1 R0.6mV 1 Notched R 1 *score limit for each lead, **score for each criteria Total 13 points 1709
결과 대상환자의특성 ST절의상승및 Q파크기의합계와경색심근의관류정도의관계 1710 Fig. 2. Changes of ST and Q. Fig. 3. Change of R and QRSs. R파고의감소및 QRS 평점과조영지수의관계 Korean Circulation J 1998;2810:1707-1716
Table 2. Correlation between R, QRSs and perfusion status R Ra Rd QRSi QRSa QRSd OI r 0.53 0.51 0.59 0.51 0.61 0.33 No of OS0 0.59 0.66 0.43 0.58 0.58 0.57 No of OS0.5 NS NS NS NS NS NS OIopacification index iinitial study OSopacification score apost-angiography 90 minutes study QRSQRS score dpre-discharge study Fig. 4. Regression analysis between OI and R. 조영점수에따른 R파고의총합과 QRS평점의변화 1711
Fig. 5. Comparision of R between groups. Fig. 7. Comparision of QRSs between groups. Fig. 6. Sequential changes of R within a specific group. 1712 Fig. 8. Sequential changes of QRSs within a specific group. ST절의하강정도에따른심근관류정도의비교 Korean Circulation J 1998;2810:1707-1716
고찰 ST절및 Q파의변화와관류지수와의관계 1713
R 파고및 QRS 평점과관류정도의상관관계 1714 결론 Korean Circulation J 1998;2810:1707-1716
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