Vandenberg B F, Romhilt D W
Department of Medicine, University of Iowa, Iowa City 52242.
Am Heart J. 1991 Sep;122(3 Pt 1):818-22. doi: 10.1016/0002-8703(91)90530-u.
Autopsy and echocardiographic studies indicate that ECG criteria for LVH tend to maintain their sensitivity in the presence of LBBB, with the exception of left precordial lead criteria alone. With RBBB, ECG criteria for LVH using right precordial S waves and combination criteria of right precordial S waves and left precordial R waves have a marked reduction in sensitivity, whereas left precordial R wave criteria have modestly reduced sensitivity. Limb lead criteria for LVH have increased sensitivity in the presence of RBBB and, to a lesser extent, in the presence of LBBB. Acceptable sensitivity for the diagnosis of LVH in patients with bundle branch block requires a combination of limb and precordial lead voltage criteria and/or other nonvoltage ECG criteria, since the prevalence of LVH in the presence of RBBB or LBBB appears higher than the sensitivity of individual criteria.
尸检和超声心动图研究表明，除单独的左胸前导联标准外，左心室肥厚（LVH）的心电图标准在存在左束支传导阻滞（LBBB）时往往能保持其敏感性。对于右束支传导阻滞（RBBB），使用右胸前S波的LVH心电图标准以及右胸前S波和左胸前R波的联合标准的敏感性显著降低，而左胸前R波标准的敏感性则有适度降低。LVH的肢体导联标准在存在RBBB时敏感性增加，在存在LBBB时敏感性增加程度较小。对于束支传导阻滞患者，诊断LVH的可接受敏感性需要肢体导联和胸前导联电压标准及/或其他非电压心电图标准的组合，因为在存在RBBB或LBBB时LVH的患病率似乎高于单个标准的敏感性。
