Book W M, Parks W J, Hopkins K L, Hurst J W
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Clin Cardiol. 1999 Nov;22(11):740-6. doi: 10.1002/clc.4960221113.
Right ventricular dysfunction occurs in many patients with significant pulmonary valve regurgitation late after initial total repair of tetralogy of Fallot. Methods to predict which of these patients are at increased risk of late morbidity and mortality are not yet known.
This study evaluated electrocardiographic (ECG) predictors of severe right ventricular dilatation determined by magnetic resonance imaging (MRI) volumes in patients with tetralogy of Fallot late after initial corrective repair.
We retrospectively reviewed the ECGs and MRI right ventricular volume measurements of 20 patients (age 4.4 to 19.3 years, mean 10.0 years) with significant pulmonary valve regurgitation late after repair of tetralogy of Fallot. All patients had enlarged, hypokinetic right ventricles by echocardiography. The patients were grouped based on an indexed right ventricular end-diastolic volume (RVEDV/BSA) of < 102 ml/m2 (Group 1) or > or = 102 ml/m2 (Group 2). We determined the sensitivity, specificity, positive and negative predictive values of QRS duration, and mean frontal plane QRS axis for predicting right ventricular volumes.
A maximal QRS duration of > or = 150 ms or a northwest quadrant frontal plane QRS axis had 85% sensitivity, 86% specificity, 92% positive predictive value, and 75% negative predictive value for predicting an RVEDV/BSA of > or = 102 ml/m2. The mean QRS duration was significantly longer in Group 2 than in Group 1 patients (156 ms vs. 125 ms, p = 0.005).
In patients late after repair of tetralogy of Fallot with significant pulmonary valve regurgitation a maximal manually measured QRS duration of > or = 150 ms and/or a frontal plane QRS northwest quadrant axis can predict patients with marked right ventricular enlargement. The presence of either of these findings on the ECG signifies patients who require further evaluation and consideration for pulmonary valve replacement.
在法洛四联症初次完全修复术后晚期，许多有严重肺动脉瓣反流的患者会出现右心室功能障碍。目前尚不清楚预测哪些患者发生晚期发病和死亡风险增加的方法。
本研究评估了法洛四联症初次矫正修复术后晚期患者中，通过磁共振成像（MRI）容积测定的严重右心室扩张的心电图（ECG）预测指标。
我们回顾性分析了20例法洛四联症修复术后晚期有严重肺动脉瓣反流患者（年龄4.4至19.3岁，平均10.0岁）的心电图和MRI右心室容积测量结果。所有患者经超声心动图检查均显示右心室扩大、运动减弱。根据右心室舒张末期容积指数（RVEDV/BSA）<102 ml/m²（第1组）或≥102 ml/m²（第2组）对患者进行分组。我们确定了QRS波时限和平均额面QRS电轴预测右心室容积的敏感性、特异性、阳性和阴性预测值。
最大QRS波时限≥150 ms或额面QRS电轴位于西北象限，对于预测RVEDV/BSA≥102 ml/m²具有85%的敏感性、86%的特异性、92%的阳性预测值和75%的阴性预测值。第2组患者的平均QRS波时限显著长于第1组患者（156 ms对125 ms，p = 0.005）。
在法洛四联症修复术后晚期且有严重肺动脉瓣反流的患者中，手动测量的最大QRS波时限≥150 ms和/或额面QRS电轴位于西北象限可预测右心室明显扩大的患者。心电图上出现这些发现之一表明患者需要进一步评估并考虑进行肺动脉瓣置换。
