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本文在369例经活动平板试验和铊显象检查的患者中对诊断不典型(remote)后壁心肌梗塞的4项心电图标准的精确性进行了前瞻性的评价。诊断标准如下:V_1导联R波宽度≥0.04秒,且R波≥S波;V_2导联R波≥S波;V_2T波电压减去V_9T波电压≥0.38mV(T波指数);在左脊椎旁线的V_9导联Q渡≥0.04秒。27例患者(7.3%)符合铊显象后壁心肌梗塞的标准,即在左心室后壁基底部有持续性灌注缺损。4项标准的敏感性为4～56%,特异性为64～99%。背部左脊椎旁线V_9导联提供了最佳预测的准确性(94%)和阳性预测值(58%),且能区分符合上述任何一项标准的患
We prospectively evaluated the accuracy of 4 electrocardiographic criteria for diagnosis of posterior wall myocardial infarction in 369 patients who underwent active treadmill testing and thallium imaging. Diagnostic criteria are as follows: V_1 lead R wave width ≥ 0.04 seconds, and R wave ≥ S wave; V_2 lead R wave ≥ S wave; V_2T wave voltage minus V_9T wave voltage ≥ 0.38mV (T wave index) Next to the V_9 lead Q crossing ≥0.04 seconds. Twenty-seven patients (7.3%) met the criteria for thallium posterior wall myocardial infarction with persistent perfusion defects at the base of the posterior wall of the left ventricle. The sensitivity of the 4 criteria is 4 to 56% with a specificity of 64 to 99%. The posterior left-sided paraspinal V_9 lead provided the best (94%) predictive accuracy and positive predictive value (58%) predictive of outcome and was able to distinguish between those who met any of these criteria