Department of Physiological Sciences, Federal University of Espírito Santo, Av Marechal Campos 1468, Maruipe, Vitória, ES 29042-755, Brazil.
Clin Res Cardiol. 2013 Sep;102(9):653-9. doi: 10.1007/s00392-013-0578-x. Epub 2013 May 10.
According to hypertension guidelines, the recommended electrocardiographic (ECG) diagnostic criteria for left ventricular hypertrophy (LVH) are the Sokolow-Lyon and Cornel voltage criteria, both with general acceptance by primary care physicians. However, it was recently reported that the R-wave voltage in lead aVL (RaVL) was as good as other more complicated and time-consuming ECG criteria to detect LVH in hypertensive patients. Therefore, our aim was to investigate if the ability of the RaVL to identify echocardiographic left ventricular hypertrophy (ECHO-LVH) could be translated to the general population, a more realistic assessment of its utility in a nonreferral setting.
682 participants (43.5 % males), aged between 27 and 72 years from the urban population of Vitoria, ES, Brazil, were enrolled. We investigated the association of ECHO-LVH (LV mass >51 g/Ht(2.7)) with several ECG voltage measurements: Sokolow-Lyon and Cornel criteria, S-wave voltage in lead V3 (SV3) and RaVL.
The RaVL showed the best positive correlation with LV mass indexed to Ht(2.7), superior to both Cornell and Sokolow-Lyon criteria and was not influenced by gender. Analysis of the ROC curves showed that the RaVL depicted a significant superior performance in relation to all the other measurements in the ability to detect ECHO-LVH. SV3 was not correlated with LV mass. Thus, it seems that most of Cornell's performance depends on its simplified version, that is, RaVL.
We have shown that the simple and single assessment of RaVL presented a greater diagnostic ability in detecting ECHO-LVH in the general population, signaling its value mainly as a screening tool.
根据高血压指南，左心室肥厚（LVH）的推荐心电图（ECG）诊断标准是 Sokolow-Lyon 和 Cornel 电压标准，这两个标准都被初级保健医生普遍接受。然而，最近有报道称，aVL 导联（RaVL）的 R 波电压与其他更复杂和耗时的 ECG 标准一样，可用于检测高血压患者的 LVH。因此，我们的目的是研究 RaVL 识别超声心动图左心室肥厚（ECHO-LVH）的能力是否可以转化为普通人群，这是对其在非转诊环境中的实用性的更现实评估。
从巴西 ES 州维多利亚市的城市人群中招募了 682 名年龄在 27 至 72 岁之间的参与者（43.5%为男性）。我们研究了 ECHO-LVH（LV 质量>51 g/Ht(2.7)）与几个 ECG 电压测量值的关系：Sokolow-Lyon 和 Cornel 标准、V3 导联的 S 波电压（SV3）和 RaVL。
RaVL 与 LV 质量与 Ht(2.7)的比值呈最佳正相关，优于 Cornell 和 Sokolow-Lyon 标准，且不受性别影响。ROC 曲线分析表明，RaVL 在检测 ECHO-LVH 的能力方面优于所有其他测量值。SV3 与 LV 质量不相关。因此，似乎 Cornell 的大部分表现都取决于其简化版本，即 RaVL。
我们已经表明，RaVL 的简单和单一评估在检测普通人群中的 ECHO-LVH 方面具有更大的诊断能力，表明其主要作为一种筛查工具的价值。
