The Electrocardiographic Findings And Clinical Significance Of T-wave Shape In Lead AVR In Patients With Three-vessel Of Acute Coronary Syndrome

Objective:To investigate the electrocardiographic findings of patients with three-vessel disease(3-VD)of acute coronary syndrome(ACS),and to study the clinical value of T-wave shape of lead aVR in predicting left ventricular function in patients with 3-VD.Methods:A total of 241 patients with ACS diagnosed in the third ward of the department of cardiology of the Second Hospital of Shanxi Medical University from June 2019 to September 2019 were selected.There were 68 patients with ST-segment elevation myocardial infarction(STEMI)and 173 patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS)including 128 patients with unstable angina pectoris(UAP)and 45 patients with non-ST-segment elevation myocardial infarction(NSTEMI).A total of 160 patients with 3-VD were divided into T-wave upright group(T ? 0 mv)and T-wave inversion group(T < 0mv)according to the shape of T-wave in lead aVR.The left ventricular function,coronary angiography and clinical outcome of the two groups were compared to determine the clinical value of T-wave shape in lead aVR.Results:1.1 The age in NSTEMI group was significantly higher than that in UAP group and STEMI group,the difference was statistically significant(P<0.05).The proportion of previous cerebral infarction in NSTEMI group was significantly higher than that in UAP group(P<0.05).The systolic blood pressure in NSTEMI and STEMI group was lower than that in UAP group,blood glucose was higher than that in UAP group(P<0.05).With the progression of ACS,the left ventricular ejection fraction(LVEF)decreased gradually,the LVEF in STEMI group was lower than that in UAP group(P<0.05),but there was no significant difference between STEMI group and MSTEMI group(P>0.05).2.1 In patients with NSTE-ACS,the electrocardiographic pattern of 3-VD or left main artery(LM)lesions was the depression of ST segment in lead V4~V6,I and II,accompanied by elevation of ST segment in lead aVR.2.2 In patients with NSTE-ACS,the percentage of T-wave upright in lead aVR in LM group and 3-VD group was significantly higher compared those with 2-VD(all P<0 05).3.1 In patients with STEMI,the elevated number of ST segment in lead V6,I and aVL,the upright number of T wave in lead aVR and the proportion of low voltage in 3-VD group were significantly higher than those in non-3-VD group,and the 3-VD group was more likely to have extensive anterior wall complicated with high lateral wall and inferior wall myocardial infarction.(all P<0 05).3.2 In patients with STEMI,the proportion of right coronary artery and left circumflex artery lesions equal or greater than to 50% stenosis in 3-VD group was higher than that in non-3-VD group,and the degree of stenosis was more severe,the difference was statistically significant(P<0.05).4.1 In patients with patients,LVEF was lower but proportion of EF<50%,serum N-terminal pro-brain natriuretic peptide(NT-proBNP)?Gensini score?SYNTAX score?proportion of SYNTAX?23 and QTc duration were higher in T-wave upright group than those in T-wave inversion group(all P<0.05).Compared with the T-wave inversion group,the upright group had high proportion of using vasopressor and longer average hospitalization day(all P<0.05).4.2 Spearman correlation analysis showed that upright T-wave in lead aVR was negatively correlated with LVEF,and positively correlated with Gensini and SYNTAX score?NT-proBNP?EF and hospitalization day(all P<0.05).4.3 Multivariate linear regression analysis showed that upright T wave in lead aVR(?eta=-0.133,P=0.025)?NT-proBNP(?eta=-0.270,P=0.000)and left atrial volum(?eta=-0.182,P=0.005)were main influence factors for left ventricual ejection fraction.Conclusion:The characteristic electrocardiogram findings of patients with 3-VD in NSTE-ACS was that ST depression in lead V4~V6,I and II accompanied by elevation of ST segment and upright T-wave in lead aVR.Patients with 3-VD in STEMI were likely to becomplicated with lateral wall myocardial infarction.Upright T-wave in lead aVR may predict worse left ventricular function in patients of ACS with 3-VD.