Department of Cardiac and Vascular Diseases, John Paul II Hospital, Kraków, Poland.
Circ J. 2012;76(7):1744-9. doi: 10.1253/circj.cj-11-1517. Epub 2012 Apr 13.
Currently, there are no data on the association between right ventricular (RV) structure and ECG changes specific for idiopathic pulmonary arterial hypertension (IPAH). Therefore, we aimed to assess the accuracy of the recommended ECG criteria for predicting RV hypertrophy (RVH) and dilation in patients with IPAH.
Twelve-lead ECG and cardiovascular magnetic resonance imaging (CMR) were performed in 23 consecutive patients with IPAH aged 49.8±16.3 years. ECG criteria were referred to RV mass index and RV end-diastolic volume index as measured by CMR. Only the ECG voltage criteria based on R wave amplitude in lead V1, R wave amplitude in aVR, P wave amplitude in II and ventricular activation time in V1 were useful for differentiating between patients with and without RVH. A ventricular activation time in lead V1 of <0.01 s excluded RVH, whereas R in V1 >6 mm, R:S in V1 >1, R in aVR >4 mm, R:S in V5 to R:S in V1 <0.04 and P in II >2.5 mm confirmed the diagnosis. Only the ventricular activation time in V1 correlated with RV dilation and when >0.045s confirmed its diagnosis.
Only a few of the recommended ECG criteria proved to be useful in the diagnosis of RVH or RV dilation in patients with IPAH. Changes in the cut-off values improved their accuracy.
目前，尚无右心室（RV）结构与特发性肺动脉高压（IPAH）特定的心电图变化之间关联的数据。因此，我们旨在评估推荐的心电图标准在预测 IPAH 患者 RV 肥厚（RVH）和扩张中的准确性。
对 23 例年龄为 49.8±16.3 岁的连续 IPAH 患者进行了 12 导联心电图和心血管磁共振成像（CMR）检查。心电图标准参考 RV 质量指数和 CMR 测量的 RV 舒张末期容积指数。仅 V1 导联 R 波振幅、aVR 导联 R 波振幅、II 导联 P 波振幅和 V1 导联心室激活时间的 ECG 电压标准有助于区分 RVH 和非 RVH 患者。V1 导联心室激活时间<0.01s 排除 RVH，而 V1 导联 R>6mm、V1 导联 R:S>1、aVR 导联 R>4mm、V5 导联 R:S 至 V1 导联 R:S<0.04 和 II 导联 P>2.5mm 则确诊 RVH。仅 V1 导联心室激活时间与 RV 扩张相关，当>0.045s 时可确诊 RV 扩张。
推荐的心电图标准中只有少数标准对 IPAH 患者 RVH 或 RV 扩张的诊断有用。改变截断值可提高其准确性。
