russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLCrussjcardiol-2247Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESНЕИНВАЗИВНАЯ ОЦЕНКА РЕЗУЛЬТАТОВ ТРОМБОЛИТИЧЕСКОЙ ТЕРАПИИ ПРИ ОСТРОМ ИНФАРКТЕ МИОКАРДА: ДИНАМИКА ЭЛЕВАЦИИ СЕГМЕНТА ST И ЗУБЦА Т НА ЭЛЕКТРОКАРДИОГРАММЕNon-invasive assessment of thrombolysis results in acute myocardial infarction: electrocardiogram dynamics of ST segment elevation and T waveБерштейнЛ. Л.BersteinL. L.

кафедра кардиологии им. М.С.Кушаковского

Медицинская академия последипломного образованияРоссия200728122007063741Copyright © Берштейн Л.Л., 20072007Берштейн Л.Л.Berstein L.L.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/2247

Оценка эффективности реперфузии при остром инфаркте миокарда (ОИМ) является важной клинической задачей. Проведен анализ динамики сегмента STu зубца Ту 106 пациентов с ОИМ с подъемом ST нa трех электрокардиограммах - исходной, через 3 и 48 ч после тромболизиса (ЭКГ-1, 2 и 3). Отдельно для передних и непередних инфарктов оценивались степень снижения ST в отведении с его максимальной элевацией (снижение ST max ПИМ и НПИМ) и уменьшение суммарной элевации ST во всех отведениях с его подъемом (снижение STsum ПИМ и НПИМ). Также рассчитывались суммарные амплитуды зубцов Т в отведениях с элевацией ST на ЭКГ-2 и ЭКГ-3 (sumT2, sumT3); их разность между ЭКГ-2 и ЭКГ-1 (sumT2-sumT1) и между ЭКГ-3 и ЭКГ-1 (sum. T3-sum. T1). Об эффективности реперфузии судили по уменьшению индекса локальной сократимости левого желудочка через 10±3 дня после тромболизиса. Чувствительность и специфичность изученных критериев реперфузии с указанием рассчитанных для них точек разделения: sumT3-sumT1≤28*: 68 и 76 %; снижение STsum ПИМ>44, 0 % - 81 и 62; снижение STsum НПИМ>58, 8 %* - 100 и 42 %; снижение STmax НПИМ>66, 7 %* - 83 и 53 %; снижение STmax ПИМ>33, 3 %* - 81 и 54 %; sumT3<10* - 98и 30 %; sumT2-sumT1<28* - 39 и 86 %; sumT2<14-75 и 43 % (*р<0, 05). Анализ доступных электрокардиографических показателей позволяет оценивать эффективность миокардиальной реперфузии после ОИМ.

The assessment of reperfusion effectiveness in acute myocardial infarction (AMI) is an important clinical task. In 106 AMI patients with ST elevation, the dynamics of ST segment and Twave was analyzed using the data of three electrocardiograms (baseline, 3 and 48 hours after thrombolysis - ECG-1, 2, and 3, respectively). Separately for anterior and поп-anterior AMI, ST decrease degree in the lead with its maximal elevation (STmax decrease aAMI, naAMI), as well as decrease in total ST elevation in all leads with its elevation (STsum decrease aAMI, naAMI) were analyzed. Other parameters calculated included summary T wave amplitudes in leads with ST elevation on ECG-2 and ECG-3 (sumT2, sumT3), their difference between ECG-2 and ECG-3 (sumT2-sumT1) or between ECG-3 and ECG-1 (sumT3-sumT1). Reperfusion effectiveness was assessed by local left ventricular contractility index reduction 10±3 days after thrombolysis. Sensitivity and specificity of these criteria, with calculated cut-off levels, were as follows: sumT3-sumTl?28*: 68 and 76 %; STsum decrease aAMI >44, 0 % - 81 and 62 %; STsum decrease naAMI >58, 8 %* - 100 and 42 %; STmax decrease naAMI>66, 7 %* - 83 and 53 %; STmax decrease aAMI>33, 3 %* - 81 and 54 %; sumT3<10* - 98 and 30 %; sumT2-sumT1?28* - 39 and 86 %; sumT2<14 -75 and 43 % (*p<0, 05). Analyzing simple electrocardiography parameters could facilitate the assessment of myocardial reperfusion effectiveness in AMI.

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The authors declare that there are no conflicts of interest present.