[心电图在肺动脉高压患者中的诊断价值]

[Diagnosis value of electrocardiogram in patients with pulmonary artery hypertension].

作者信息

Zhao Qin-hua, Xu Xi-Qi, Jing Zhi-cheng, Sun Ming-li, Dai Li-zhi, Wu Wen-hui, Jiang Xin, He Jing, Li Yun

机构信息

Department of Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2010 Apr;38(4):346-9.

PMID:20654082

Abstract

OBJECTIVES

To analyze the diagnostic value of electrocardiogram (ECG) in patients with pulmonary artery hypertension (PAH) confirmed by right-heart catheterization (RHC).

METHODS

A total of 64 patients with suspected PAH [sPAP > or = 36 mm Hg (1 mm Hg = 0.133 kPa) estimated by echocardiography] were enrolled in this study. All patients were examined by 12-lead ECG within half an hour before RHC.

RESULTS

PAH was excluded in 26 patients and confirmed in 38 patients. ECG analysis showed that S amplitude > 0.21 mV in lead I, QRS axis > 87 degrees , R(V1) + S(V5) > 0.76 mV were good parameters for diagnosing PAH with sensibility and specificity of 89%, 81%; 86%, 92%; 84%, 83%, respectively. QRS axis was positively correlated with mean pulmonary artery pressure (mPAP) (r = 0.75, P < 0.001), R(V1) + S(V5) was positively correlated with pulmonary vascular resistance (PVR) (r = 0.74, P < 0.001), R(V1) + S(V5) and S amplitude in lead I was negatively correlated with cardiac index (CI) (r = -0.62, P < 0.001).

CONCLUSION

ECG combined with echocardiography are adequate screening tools to rule out the presence of PAH. QRS axis, R(V1) + S(V5) and S amplitude in lead I were significantly correlated with hemodynamic parameters derived from RHC in PAH patients.

摘要

目的

分析心电图（ECG）对经右心导管检查（RHC）确诊的肺动脉高压（PAH）患者的诊断价值。

方法

本研究纳入了64例疑似PAH患者[经超声心动图估计sPAP≥36 mmHg（1 mmHg = 0.133 kPa）]。所有患者在RHC前半小时内接受12导联心电图检查。

结果

26例患者排除PAH，38例患者确诊PAH。心电图分析显示，I导联S波振幅>0.21 mV、QRS电轴>87°、R（V1）+S（V5）>0.76 mV是诊断PAH的良好参数，敏感性和特异性分别为89%、81%；86%、92%；84%、83%。QRS电轴与平均肺动脉压（mPAP）呈正相关（r = 0.75，P < 0.001），R（V1）+S（V5）与肺血管阻力（PVR）呈正相关（r = 0.74，P < 0.001），R（V1）+S（V5）和I导联S波振幅与心脏指数（CI）呈负相关（r = -0.62，P < 0.001）。