Department of Paediatric Nephrology, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Arch Dis Child. 2010 Oct;95(10):832-6. doi: 10.1136/adc.2009.168377. Epub 2010 Jul 23.
Detection of left ventricular hypertrophy (LVH) is clinically important because it can be predictive of adverse clinical outcome. However, the best method for detecting LVH in clinical practice is unclear. The aim of this study was to evaluate electrocardiography (ECG) compared with echocardiography (ECHO) as a screening test to detect LVH in a high risk population.
In a prospective, double-blinded, single centre analysis of a population of children with chronic kidney disease, LVH detected using standard 12-lead ECG (ECG-LVH) was compared with that detected with 2D-guided M-mode ECHO (ECHO-LVH). Two electrocardiographic methods (A and B) were used to diagnose ECG-LVH and compared with three different indexation methods to define ECHO-LVH.
70 consecutively enrolled participants had 107 ECG and ECHO studies performed on the same day. The prevalence of ECHO-LVH ranged from 17% to 55% using different indexation methods. Increased R wave amplitude using recent age and gender specific voltage criteria (ECG method B) demonstrated the highest sensitivity (68-76%) and specificity (43-77%) for detecting ECHO-LVH. The negative predictive value (NPV) for R waves using ECG method B was 52.4% (range 40-68.6%). For all other ECG criteria, sensitivity did not exceed 13% irrespective of the ECG or ECHO method used.
In children, the standard 12-lead electrocardiogram has low sensitivity and low NPV for detecting LVH. These findings are relevant for physiological LVH and should not be extrapolated to detection of hypertrophic cardiomyopathy. In clinical practice, ECHO alone should be used to exclude LVH.
左心室肥厚（LVH）的检测在临床上很重要，因为它可以预测不良的临床结局。然而，目前临床上检测 LVH 的最佳方法尚不清楚。本研究旨在评估心电图（ECG）与超声心动图（ECHO）相比作为一种筛查试验，用于检测高危人群中的 LVH。
在一项针对患有慢性肾脏病的儿童的前瞻性、双盲、单中心分析中，使用标准的 12 导联心电图（ECG-LVH）检测到的 LVH 与使用 2D 引导的 M 型 ECHO（ECHO-LVH）检测到的 LVH 进行了比较。使用两种心电图方法（A 和 B）诊断 ECG-LVH，并与三种不同的指数化方法进行比较，以定义 ECHO-LVH。
70 名连续入组的参与者在同一天进行了 107 次 ECG 和 ECHO 检查。使用不同的指数化方法，ECHO-LVH 的患病率从 17%到 55%不等。使用最近的年龄和性别特异性电压标准（心电图方法 B）增加 R 波振幅，对检测 ECHO-LVH 的敏感性（68-76%）和特异性（43-77%）最高。心电图方法 B 的 R 波阴性预测值（NPV）为 52.4%（范围 40-68.6%）。对于所有其他心电图标准，无论使用哪种 ECG 或 ECHO 方法，敏感性均不超过 13%。
在儿童中，标准的 12 导联心电图检测 LVH 的敏感性和 NPV 均较低。这些发现与生理性 LVH 相关，不应推断为肥厚型心肌病的检测。在临床实践中，应单独使用 ECHO 排除 LVH。
