Bacharova L, Kyselovic J
International Laser Center, Bratislava, Slovak Republic.
Med Hypotheses. 2001 Oct;57(4):487-90. doi: 10.1054/mehy.2001.1371.
The current ECG diagnosis of LVH is based on QRS voltage criteria and aims to estimate left ventricular mass. Its underlying hypothesis includes unstated assumptions about the non-spatial determinants of QRS voltage;that the electrical properties of hypertrophied myocardium do not differ from those healthy myocardium, and that they are not changed in the course of developing LVH. Since these two assumptions are not true, the performance of the voltage criteria is limited and is reflected in the high number of so-called false negative ECG results, as well as their low sensitivity. The reconsidered hypothesis is based on a more complex understanding of LVH and on the analysis of information provided by electrocardiography. It considers false negative results for LVH diagnosis as a relative voltage deficit, and introduces a new parameter for its quantification: the specific potential (the relative QRS voltage).The relative voltage deficit is related to changes of active and passive electrical properties (electrophysiological remodelling) of the hypertrophied myocardium. This new hypothesis also takes into account changes of the relative QRS voltage in different stages of LVH. The potential of this concept is its usefulness as a parameter in the frame of diagnostics of LVH, of diffuse changes of myocardium, in cardiovascular risk assessment, and well as for evaluation of the effects of therapy.
目前左心室肥厚的心电图诊断基于QRS波电压标准，旨在估计左心室质量。其潜在假设包括关于QRS波电压非空间决定因素的未明确假设；肥厚心肌的电特性与健康心肌无异，且在左心室肥厚发展过程中不会改变。由于这两个假设并不成立，电压标准的性能受到限制，表现为大量所谓的心电图假阴性结果以及低敏感性。重新考虑的假设基于对左心室肥厚更复杂的理解以及对心电图提供信息的分析。它将左心室肥厚诊断的假阴性结果视为相对电压不足，并引入一个新参数对其进行量化：比电位（相对QRS波电压）。相对电压不足与肥厚心肌的主动和被动电特性变化（电生理重塑）有关。这个新假设还考虑了左心室肥厚不同阶段相对QRS波电压的变化。这一概念的潜力在于它作为一个参数，在左心室肥厚诊断、心肌弥漫性改变诊断、心血管风险评估以及治疗效果评估等方面具有实用性。
