Human Adaptation and Countermeasures Division, NASA Johnson Space Center, Houston, TX, USA.
BMC Cardiovasc Disord. 2010 Jun 16;10:28. doi: 10.1186/1471-2261-10-28.
Resting conventional 12-lead ECG has low sensitivity for detection of coronary artery disease (CAD) and left ventricular hypertrophy (LVH) and low positive predictive value (PPV) for prediction of left ventricular systolic dysfunction (LVSD). We hypothesized that a approximately 5-min resting 12-lead advanced ECG test ("A-ECG") that combined results from both the advanced and conventional ECG could more accurately screen for these conditions than strictly conventional ECG.
Results from nearly every conventional and advanced resting ECG parameter known from the literature to have diagnostic or predictive value were first retrospectively evaluated in 418 healthy controls and 290 patients with imaging-proven CAD, LVH and/or LVSD. Each ECG parameter was examined for potential inclusion within multi-parameter A-ECG scores derived from multivariate regression models that were designed to optimally screen for disease in general or LVSD in particular. The performance of the best retrospectively-validated A-ECG scores was then compared against that of optimized pooled criteria from the strictly conventional ECG in a test set of 315 additional individuals.
Compared to optimized pooled criteria from the strictly conventional ECG, a 7-parameter A-ECG score validated in the training set increased the sensitivity of resting ECG for identifying disease in the test set from 78% (72-84%) to 92% (88-96%) (P < 0.0001) while also increasing specificity from 85% (77-91%) to 94% (88-98%) (P < 0.05). In diseased patients, another 5-parameter A-ECG score increased the PPV of ECG for LVSD from 53% (41-65%) to 92% (78-98%) (P < 0.0001) without compromising related negative predictive value.
Resting 12-lead A-ECG scoring is more accurate than strictly conventional ECG in screening for CAD, LVH and LVSD.
静息常规 12 导联心电图（ECG）对冠心病（CAD）和左心室肥厚（LVH）的检测灵敏度较低，对左心室收缩功能障碍（LVSD）的预测阳性预测值（PPV）较低。我们假设，一种大约 5 分钟的静息 12 导联高级 ECG 测试（“A-ECG”），结合了高级和常规 ECG 的结果，比严格的常规 ECG 更能准确地筛查这些疾病。
首先回顾性评估了近 418 名健康对照者和 290 名经影像学证实的 CAD、LVH 和/或 LVSD 患者的几乎所有文献中已知具有诊断或预测价值的常规和高级静息 ECG 参数。根据旨在优化筛查一般疾病或特定 LVSD 的多变量回归模型，对每个 ECG 参数进行了潜在纳入多参数 A-ECG 评分的检查。然后，在另外 315 名个体的测试集中，将经过回顾性验证的最佳 A-ECG 评分的性能与严格常规 ECG 的优化合并标准进行了比较。
与严格常规 ECG 的优化合并标准相比，在训练集中验证的 7 个参数 A-ECG 评分提高了静息 ECG 在测试集中识别疾病的敏感性，从 78%（72-84%）提高到 92%（88-96%）（P <0.0001），同时特异性也从 85%（77-91%）提高到 94%（88-98%）（P <0.05）。在患病患者中，另一个 5 个参数的 A-ECG 评分提高了心电图对 LVSD 的 PPV，从 53%（41-65%）提高到 92%（78-98%）（P <0.0001），而不会影响相关的阴性预测值。
静息 12 导联 A-ECG 评分比严格的常规 ECG 在筛查 CAD、LVH 和 LVSD 方面更准确。
