Jain Rahul, Dalal Darshan, Daly Amy, Tichnell Crystal, James Cynthia, Evenson Ariana, Jain Rohit, Abraham Theodore, Tan Boon Yew, Tandri Hari, Russell Stuart D, Judge Daniel, Calkins Hugh
Carnegie 530, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore MD 21287, USA.
Circulation. 2009 Aug 11;120(6):477-87. doi: 10.1161/CIRCULATIONAHA.108.838821. Epub 2009 Jul 27.
The purpose of this study was to reevaluate the ECG features of arrhythmogenic right ventricular dysplasia (ARVD). The second objective was to evaluate the sensitivity and specificity of the standard and newly proposed diagnostic ECG markers in the presence of a right bundle-branch block (RBBB).
One hundred patients with ARVD (57 men; aged 39+/-15 years) and 57 controls (21 men; aged 40+/-17 years) were included. Among the 100 patients with ARVD, a complete RBBB was present in 17 patients, and 15 patients had an incomplete RBBB. T-wave inversion through V(3) demonstrated optimal sensitivity and specificity in both ARVD patients without a complete RBBB or incomplete RBBB (71% [95% confidence interval, 58% to 81%] and 96% [95% confidence interval, 81% to 100%], respectively) and in ARVD patients with incomplete RBBB (73% [95% confidence interval, 45% to 92%] and 95% [95% confidence interval, 77% to 100%], respectively). Between ARVD patients and controls with a complete RBBB, the only 2 parameters that differed were the prevalence of T-wave inversion through V(4) (59% versus 12%, respectively; P<0.05) and an r'/s ratio in V(1) <1 (88% versus 14%, respectively; P<0.005). In ARVD patients with complete RBBB, the most sensitive and specific parameter was an r'/s ratio <1.
We evaluated comprehensively the diagnostic value of ECG markers for ARVD. On the basis of the findings, we propose an algorithm, with examination of QRS morphology being the first step, for ECG evaluation of ARVD patients. Definite criteria are then applied on the basis of the presence of no RBBB, incomplete RBBB, and complete RBBB to obtain the best diagnostic utility of the ECG.
本研究旨在重新评估致心律失常性右室心肌病（ARVD）的心电图特征。第二个目的是评估在存在右束支传导阻滞（RBBB）的情况下，标准及新提出的诊断性心电图标志物的敏感性和特异性。
纳入100例ARVD患者（57例男性；年龄39±15岁）和57例对照者（21例男性；年龄40±17岁）。在100例ARVD患者中，17例存在完全性RBBB，15例存在不完全性RBBB。在无完全性或不完全性RBBB的ARVD患者以及存在不完全性RBBB的ARVD患者中，V₃导联T波倒置均显示出最佳的敏感性和特异性（分别为71%[95%置信区间，58%至81%]和96%[95%置信区间，81%至100%]；73%[95%置信区间，45%至92%]和95%[95%置信区间，77%至100%]）。在存在完全性RBBB的ARVD患者与对照者之间，仅有的两个不同参数是V₄导联T波倒置的发生率（分别为59%对12%；P<0.05）以及V₁导联r'/s比值<1（分别为88%对14%；P<0.005）。在存在完全性RBBB的ARVD患者中，最敏感和特异的参数是r'/s比值<1。
我们全面评估了心电图标志物对ARVD的诊断价值。基于这些发现，我们提出一种算法，以QRS形态检查作为第一步，用于ARVD患者的心电图评估。然后根据无RBBB、不完全性RBBB和完全性RBBB的情况应用明确标准，以获得心电图的最佳诊断效用。
