Salvador M, Begasse F, Guittard J, Chamontin B
Service de médecine interne et d'hypertension artérielle, CHU Purpan, Toulouse.
Arch Mal Coeur Vaiss. 1992 Jan;85(1):39-43.
The diagnostic value of electrocardiographic P wave analysis in the frontal plane was assessed with respect to previously reported abnormalities: right atrial hypertrophy-dilatation; an enlarged, crenalleted summit without criteria of right atrial hypertrophy. Two observers studied the ECG recordings of 20 hypertensive patients with pheochromocytomas: 10 men and 10 women, aged 45.5 +/- 16 years, and in 30 patients with essential hypertension, 15 men and 15 women, aged 48.9 +/- 9 years (NS). The duration of hypertension was 2.6 +/- 2 years versus 4.7 +/- 4 years (p = 0.02). Right atrial hypertrophy-dilatation was observed in 5 patients in the pheochromocytoma group and in none of the essential hypertensive patients: an isolated abnormality of the summit of the P wave was observed in 5 other cases of pheochromocytoma and by 1 observer in 1 of the essential hypertension. These abnormalities disappeared after ablation of the tumour. These changes were not recorded in 3 patients who had predominant noradrenaline hypersecretion; nevertheless, comparison of the urinary adrenaline, noradrenaline, normeta- and metanephrine levels were inconclusive. No relationship was established between these concentrations, global urinary catecholamines and meta block, the duration of hypertension, the frequency and level of hypertensive crises, or the presence of "ischaemic" ST-T wave changes. P wave changes are thought to be related to high plasma catecholamine levels irrespective of the clinical impact; the sensitivity of these changes is modest (10/20) but the specificity is better within a group of hypertensive patients. An experienced observer can orient the diagnostic investigations to the search for a pheochromocytoma or to a secondary recurrence of the tumour from the surface ECG. The role of marker of a very high noradrenaline or adrenaline secretion cannot be confirmed from a series limited in separated plasma concentration measurements.
针对先前报告的异常情况，评估了额面心电图P波分析的诊断价值：右心房肥大-扩张；无右心房肥大标准的增大、有切迹的峰。两名观察者研究了20例患有嗜铬细胞瘤的高血压患者的心电图记录：10名男性和10名女性，年龄45.5±16岁，以及30例原发性高血压患者，15名男性和15名女性，年龄48.9±9岁（无显著差异）。高血压病程分别为2.6±2年和4.7±4年（p = 0.02）。嗜铬细胞瘤组有5例患者观察到右心房肥大-扩张，原发性高血压患者中未观察到：在另外5例嗜铬细胞瘤病例中观察到P波峰的孤立异常，1名观察者在1例原发性高血压患者中观察到。肿瘤切除后这些异常消失。在3例以去甲肾上腺素分泌过多为主的患者中未记录到这些变化；然而，尿肾上腺素、去甲肾上腺素、去甲变肾上腺素和变肾上腺素水平的比较尚无定论。这些浓度、总体尿儿茶酚胺和间位阻断、高血压病程、高血压危象的频率和程度或“缺血性”ST-T波改变的存在之间未建立相关性。P波改变被认为与高血浆儿茶酚胺水平有关，而与临床影响无关；这些改变的敏感性中等（10/20），但在一组高血压患者中特异性较好。经验丰富的观察者可以从体表心电图引导诊断性检查，以寻找嗜铬细胞瘤或肿瘤的二次复发。从有限的血浆浓度单独测量系列中无法证实极高去甲肾上腺素或肾上腺素分泌标志物的作用。
