Josephson M E, Kastor J A, Morganroth J
Am J Cardiol. 1977 Jun;39(7):967-71. doi: 10.1016/s0002-9149(77)80209-9.
The mechanism of the electrocardiographic pattern termed left atrial enlargement was evaluated in 21 patients. Left atrial size and pressure as well as interatrial conduction were correlated with electrocardiographic left atrial enlargement using echocardiography, mean pulmonary capillary wedge pressure and activation time from the P wave to the coronary sinus. In the group as a whole only prolongation of interatrial conduction time was consistently related to the electrocardiographic pattern of left atrial enlargement; left atrial size or pressure was not predictably abnormal in patients with this pattern. Five patients had neither elevation of pulmonary capillary wedge pressure nor echocardiographic evidence of an enlarged left atrium. When the etiologic type of heart disease was analyzed, an enlarged left atrium correlated with electrocardiographic left atrial enlargement only in patients with rheumatic mitral valve disease (eight of nine patients). Elevated pulmonary capillary wedge pressure correlated with electrocardiographic left atrial enlargement in all four patients with cardiomyopathy. In patients with coronary artery disease the electrocardiographic pattern was unrelated to either left atrial pressure or volume overload. Thus, the electrocardiographic pattern termed left atrial enlargement appears to represent an interatrial conduction defect that can be produced by a variety of factors.
对21例患者的心电图表现为左心房增大的机制进行了评估。使用超声心动图、平均肺毛细血管楔压以及从P波至冠状窦的激动时间，将左心房大小、压力以及心房内传导与心电图上的左心房增大进行关联分析。在整个研究组中，只有心房内传导时间延长始终与心电图上左心房增大的表现相关；有这种心电图表现的患者，左心房大小或压力并无可预测的异常。5例患者既无肺毛细血管楔压升高，超声心动图也未显示左心房增大。当对心脏病的病因类型进行分析时，只有风湿性二尖瓣疾病患者（9例中的8例）出现左心房增大与心电图上左心房增大相关。所有4例心肌病患者的肺毛细血管楔压升高与心电图上左心房增大相关。在冠心病患者中，心电图表现与左心房压力或容量负荷均无关。因此，心电图表现为左心房增大似乎代表了一种可由多种因素导致的心房内传导缺陷。
