Predictive value of electrocardiography for infarct size in patients with ST-segment elevation myocardial infarction
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摘要: 梗死面积是ST段抬高型心肌梗死主要不良心血管事件的独立预测指标。心脏磁共振(CMR)可全面展现梗死后心肌组织学变化特征，其晚期钆增强图像是活体检测和量化梗死面积及微血管阻塞的金标准。然而CMR获取成本较高，且存在禁忌证，而心电图评估梗死面积简便易行。本研究总结了目前心电图评估梗死面积的研究，为临床决策提供依据。
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关键词:
- 心脏磁共振 /
- 左室射血分数 /
- 梗死面积 /
- Selvester QRS评分
Abstract: Infarct size is an independent predictor of major adverse cardiovascular events in ST-segment elevation myocardial infarction. Cardiac magnetic resonance(CMR) can fully demonstrate the histological characteristics of myocardial infarction, and late gadolinium enhanced images are the gold standard for in vivo detection and quantification of infarct size as well as microvascular obstruction. However, the acquisition cost of CMR is high and there are contraindications. ECG is simple and easy to evaluate the infarct size. This study summarizes the current studies on ECG assessment of infarct size and provides evidence for clinical decision-making. -
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图 1 心电图的Selvester评分及异常标记与梗死面积
Figure 1. Selvester score, abnormal markers and infarct size of ECG
表 1 AMI梗死面积的评分系统
Table 1. Scoring system of size in AMI
研究人群来源 样本量/例 评分系统及主要发现 梗死面积测量(金标准) 杜克大学医学中心 349(正常人)+50(AMI患者) 基于12导联心电图的初始Selvester QRS评分(52项标准32分)改良为37项标准29分制的简易Selvester QRS评分系统[20-21]。 活检 急性心肌梗死-乙酰半胱氨酸临床研究(NACIAM)(澳大利亚) 60 Aldrich评分[28]：前壁梗死：3×[1.5(ST↑的导联数)-0.4]；下壁梗死：3×[0.6(∑ ST↑Ⅱ，Ⅲ，aVF)+ 2.0]
Wilkins评分[29]：前壁梗死：1.88×(ST↑的导联数)+ 2.19 ×(异常Q波的导联数)+ 1.56×(高T波的导联数)+ 5.80；下壁梗死：0.94×(∑ST↑)+ 1.13×(∑Excess Q)+ 8.73[30]心脏磁共振(LGE-CMR) 来自DETERMINE研究和PRE-DETERMINE研究的66个医学中心(美国) 551 DETERMINE评分=[有Q的导联数×2]+[FQRS的导联数]+[TWI的导联数][22]。 心脏磁共振(LGE-CMR) 
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