Ishizawa K, Ishizawa K, Motomura M, Konishi T, Wakabayashi A
Am Heart J. 1976 Jan;91(1):50-7. doi: 10.1016/s0002-8703(76)80434-6.
In 33 patients, including 12 control subjects and 21 with eccentric LVH, LV mass determined by angiocardiogram was correlated to 26 VCG measurements (Frank system) calculated from the scalar X, Y, and Z leads. The results demonstrated that the most reliable indices of VCG in assessing the severity of eccentric LVH determined by angiocardiogram were the magnitude of the spatial mean QRS vector and the time of the spatial maximal QRS vector ("spatial VAT"), of which correlation coefficients were 0.93 and 0.93, respectively. Such high correlation coefficients have never been obtained with the usual ECG analysis. These findings strongly suggest that (1) increased QRS voltage and usual prolonged QRS duration in eccentric LVH are due to an increase in LV mass, and (2) prolonged VAT observed in eccentric LVH is closely related to an anatomic alteration, namely, the greater distance of intra-ventricular conducting pathways as the result of LV dilatation, as an increase in LV mass is usually paralleled by the grade of the chamber enlargement in this type of LVH. Regarding the T loop, correlations between the LV mass and the VCG measurements were less as compared to those of the QRS loop. In general, T changes in moderate or severe LVH may be also related to a certain altered cardiac muscle state, in addition to an increase in LV mass. Angiocardiographic and light microscopic findings of a patient with eccentric LVH in whom a widened QRS-T angle was demonstrated to an extent much more than that expected with an increase in LV mass are presented and discussed. The spatial pattern analysis by VCG is very useful and reliable in assessing the severity of eccentric LVH.
在33例患者中，包括12例对照者和21例有离心性左心室肥厚（eccentric LVH）的患者，通过心血管造影测定的左心室质量与从标量X、Y和Z导联计算出的26项心向量图（VCG）测量值（Frank系统）相关。结果表明，在评估心血管造影确定的离心性左心室肥厚严重程度时，VCG最可靠的指标是空间平均QRS向量的大小和空间最大QRS向量的时间（“空间VAT”），其相关系数分别为0.93和0.93。用常规心电图分析从未获得过如此高的相关系数。这些发现强烈提示：（1）离心性左心室肥厚时QRS电压升高和通常的QRS时限延长是由于左心室质量增加所致；（2）离心性左心室肥厚中观察到的VAT延长与解剖学改变密切相关，即由于左心室扩张导致心室内传导路径距离增大，因为在这种类型的左心室肥厚中，左心室质量增加通常与心室扩大程度平行。关于T环，与QRS环相比，左心室质量与VCG测量值之间的相关性较小。一般来说，除左心室质量增加外，中度或重度左心室肥厚时的T波改变可能还与某种心肌状态改变有关。本文展示并讨论了一名离心性左心室肥厚患者的心血管造影和光镜检查结果，该患者显示出的QRS - T角增宽程度远超过左心室质量增加所预期的程度。通过VCG进行的空间模式分析在评估离心性左心室肥厚的严重程度方面非常有用且可靠。
