Molloy T J, Okin P M, Devereux R B, Kligfield P
Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021.
J Am Coll Cardiol. 1992 Nov 1;20(5):1180-6. doi: 10.1016/0735-1097(92)90376-x.
The object of this study was to assess the hypothesis that the product of QRS voltage and duration, as an approximation of the time-voltage integral of the QRS complex, can improve the electrocardiographic (ECG) identification of left ventricular hypertrophy.
Electrocardiographic identification of left ventricular hypertrophy has been limited by the poor sensitivity of standard voltage criteria. However, increases in left ventricular mass can be more closely related to increases in the time-voltage integral of the summed left ventricular dipole than to changes in voltage or QRS duration alone.
Antemortem ECGs were compared with left ventricular mass at autopsy in 220 patients. There were 95 patients with left ventricular hypertrophy, defined by left ventricular mass index > 118 g/m2 in men and > 104 g/m2 in women. The voltage-duration product was calculated as the product of QRS duration and Cornell voltage (Cornell product) and the 12-lead sum of QRS voltage (12-lead product).
At partitions with a matched specificity of 95%, each voltage-duration product significantly improved sensitivity for the detection of left ventricular hypertrophy when compared with simple voltage criteria alone (Cornell product 51% [48 of 95] vs. Cornell voltage 36% [34 of 95], p < 0.005 and 12-lead product 45% [43 of 95] vs. 12-lead voltage 31% [30 of 95], p < 0.001). Sensitivity of both the Cornell product and 12-lead product was significantly greater than that found for QRS duration alone (28%, 27 of 95, p < 0.005) and the Romhilt-Estes point score (27%, 26 of 95, p < 0.005), and compared favorably with the sensitivity of the complex Cornell multivariate score (44%, 42 of 95, p = NS). Comparison of receiver operating characteristic curves demonstrated that improved performance of the voltage-duration products for the detection of left ventricular hypertrophy was independent of test partition selection. In addition, test performance of the voltage-duration products was not significantly affected by the presence or absence of a bundle branch block.
These data suggest that the simple product of either Cornell or 12-lead voltage and QRS duration can identify left ventricular hypertrophy more accurately than can voltage or QRS duration criteria alone and may approach or exceed the performance of more complex multiple regression analyses.
本研究的目的是评估以下假设，即QRS波电压与时限的乘积作为QRS波群时间 - 电压积分的近似值，可改善心电图（ECG）对左心室肥厚的识别。
标准电压标准的低敏感性限制了心电图对左心室肥厚的识别。然而，左心室质量的增加与左心室总偶极子时间 - 电压积分的增加比单独与电压或QRS波时限的变化更密切相关。
对220例患者的生前心电图与尸检时的左心室质量进行比较。有95例左心室肥厚患者，男性左心室质量指数>118 g/m²，女性>104 g/m²定义为左心室肥厚。电压 - 时限乘积计算为QRS波时限与康奈尔电压的乘积（康奈尔乘积）以及12导联QRS波电压总和（12导联乘积）。
在特异性匹配为95%的分界点处，与单纯的简单电压标准相比，每个电压 - 时限乘积在检测左心室肥厚时均显著提高了敏感性（康奈尔乘积51%[95例中的48例]对康奈尔电压36%[95例中的34例]，p<0.005；12导联乘积45%[95例中的43例]对12导联电压31%[95例中的30例]，p<0.001）。康奈尔乘积和12导联乘积的敏感性均显著高于单独的QRS波时限（28%，95例中的27例，p<0.005）和Romhilt - Estes积分（27%，95例中的26例，p<0.005），并且与复杂的康奈尔多变量积分的敏感性（44%，95例中的42例，p =无显著性差异）相比具有优势。接受者操作特征曲线的比较表明电压 - 时限乘积在检测左心室肥厚方面的性能改善与测试分界点的选择无关。此外，电压 - 时限乘积的测试性能不受束支传导阻滞存在与否的显著影响。
这些数据表明，康奈尔或12导联电压与QRS波时限的简单乘积比单独使用电压或QRS波时限标准能更准确地识别左心室肥厚，并且可能接近或超过更复杂的多元回归分析的性能。
