Buchner Stefan, Debl Kurt, Haimerl Josef, Djavidani Behrus, Poschenrieder Florian, Feuerbach Stefan, Riegger Guenter A J, Luchner Andreas
Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany.
J Cardiovasc Magn Reson. 2009 Jun 1;11(1):18. doi: 10.1186/1532-429X-11-18.
Left ventricular hypertrophy (LVH) is a hallmark of chronic pressure or volume overload of the left ventricle and is associated with risk of cardiovascular morbidity and mortality. The purpose was to evaluate different electrocardiographic criteria for LVH as determined by cardiovascular magnetic resonance (CMR). Additionally, the effects of concentric and eccentric LVH on depolarization and repolarization were assessed.
120 patients with aortic valve disease and 30 healthy volunteers were analysed. As ECG criteria for LVH, we assessed the Sokolow-Lyon voltage/product, Gubner-Ungerleider voltage, Cornell voltage/product, Perugia-score and Romhilt-Estes score.
All ECG criteria demonstrated a significant correlation with LV mass and chamber size. The highest predictive values were achieved by the Romhilt-Estes score 4 points with a sensitivity of 86% and specificity of 81%. There was no difference in all ECG criteria between concentric and eccentric LVH. However, the intrinsicoid deflection (V6 37 +/- 1.0 ms vs. 43 +/- 1.6 ms, p < 0.05) was shorter in concentric LVH than in eccentric LVH and amplitudes of ST-segment (V5 -0.06 +/- 0.01 vs. -0.02 +/- 0.01) and T-wave (V5 -0.03 +/- 0.04 vs. 0.18 +/- 0.05) in the anterolateral leads (p < 0.05) were deeper.
By calibration with CMR, a wide range of predictive values was found for the various ECG criteria for LVH with the most favourable results for the Romhilt-Estes score. As electrocardiographic correlate for concentric LVH as compared with eccentric LVH, a shorter intrinsicoid deflection and a significant ST-segment and T-wave depression in the anterolateral leads was noted.
左心室肥厚（LVH）是左心室慢性压力或容量超负荷的标志，与心血管疾病的发病率和死亡率风险相关。目的是评估心血管磁共振（CMR）测定的不同LVH心电图标准。此外，还评估了向心性和离心性LVH对去极化和复极化的影响。
分析了120例主动脉瓣疾病患者和30名健康志愿者。作为LVH的心电图标准，我们评估了索科洛 - 里昂电压/乘积、古布纳 - 昂格勒德电压、康奈尔电压/乘积、佩鲁贾评分和罗米尔 - 埃斯评分。
所有心电图标准均与左心室质量和腔室大小显著相关。罗米尔 - 埃斯评分4分时预测价值最高，敏感性为86%，特异性为81%。向心性和离心性LVH在所有心电图标准上无差异。然而，向心性LVH的类本位曲折（V6 37±1.0毫秒对43±1.6毫秒，p<0.05）比离心性LVH短，前外侧导联的ST段振幅（V5 -0.06±0.01对-0.02±0.01）和T波振幅（V5 -0.03±0.04对0.18±0.05）更深（p<0.05）。
通过与CMR校准，发现各种LVH心电图标准具有广泛的预测价值，罗米尔 - 埃斯评分结果最佳。与离心性LVH相比，向心性LVH的心电图相关性表现为类本位曲折较短，前外侧导联有明显的ST段和T波压低。
