Bacharova Ljuba, Mateasik Anton, Krause Rolf, Prinzen Frits W, Auricchio Angelo, Potse Mark
International Laser Center, Bratislava, Slovak Republic.
J Electrocardiol. 2011 Sep-Oct;44(5):571-6. doi: 10.1016/j.jelectrocard.2011.06.004. Epub 2011 Jul 14.
The electrocardiographic (ECG) diagnosis of left ventricular hypertrophy (LVH) is based on the assumption that QRS voltage increases with left ventricular mass. However, most of patients with echocardiographically detected LVH do not have increased QRS voltage. Reduced intercellular coupling has been observed in LVH patients and animal models. The purpose of this study was to show that this uncoupling can explain relatively low QRS voltage in LVH patients.
Electrocardiograms and vectorcardiograms (VCG) were simulated with a realistic large-scale computer model of the human heart and torso that reliably represented the effects of reduced coupling on both propagation and ECG voltage.
Uncoupling reduced QRS voltage in all leads except aVL, reflecting a decrease in vector amplitude as well as a leftward axis deviation that suggested left anterior fascicular block.
Low QRS voltage does not necessarily contradict a diagnosis of LVH but may be an indication for electrical uncoupling. The diagnostic value of this "relative voltage deficit" needs to be demonstrated in clinical studies.
心电图（ECG）对左心室肥厚（LVH）的诊断基于QRS波电压随左心室质量增加这一假设。然而，大多数经超声心动图检测出LVH的患者QRS波电压并未升高。在LVH患者和动物模型中已观察到细胞间偶联减少。本研究的目的是表明这种去偶联可解释LVH患者相对较低的QRS波电压。
使用逼真的人体心脏和躯干大规模计算机模型模拟心电图和向量心电图（VCG），该模型能可靠地反映偶联减少对传导和心电图电压的影响。
除aVL导联外，去偶联降低了所有导联的QRS波电压，这反映了向量幅度减小以及提示左前分支阻滞的电轴左偏。
低QRS波电压不一定与LVH诊断相矛盾，可能是电去偶联的一个指征。这种“相对电压不足”的诊断价值需要在临床研究中得到证实。
