Lemery R, Kleinebenne A, Nihoyannopoulos P, Aber V, Alfonso F, McKenna W J
Department of Cardiological Sciences, St. Georges Hospital Medical School, London, England.
J Am Coll Cardiol. 1990 Aug;16(2):368-74. doi: 10.1016/0735-1097(90)90587-f.
The cause of abnormal Q waves in hypertrophic cardiomyopathy remains unclear. Myocardial wall thickness was assessed by two-dimensional echocardiography at 8 left ventricular and 10 right ventricular sites in 67 patients (mean age 40 years) with hypertrophic cardiomyopathy and the findings were analyzed in relation to the presence of abnormal Q waves on the 12 lead rest electrocardiogram (ECG). Nineteen (28%) of the 67 patients had abnormal Q waves. Right ventricular hypertrophy was significantly more common in patients without abnormal Q waves (25 [52%] of 48 versus 2 [11%] of 19, p less than 0.001). With univariate analysis, there were six measurements that were significantly associated with abnormal Q waves: an increase in upper anterior septal thickness (p less than 0.005) and maximal left ventricular wall thickness (p less than 0.02), a decrease in mean and maximal right ventricular wall thickness (both p less than 0.005) and an increase in the ratio of both upper anterior septal to mean right ventricular wall thickness (p less than 0.005) and upper anterior septal to upper posterior wall thickness (p less than 0.005). With multivariate analysis, only the ratios of upper anterior septal to mean right ventricular wall thickness (p less than 0.005) and to upper posterior wall thickness (p less than 0.05) were significantly related to the presence of abnormal Q waves and predicted Q wave location with a sensitivity, specificity and predictive accuracy of 90%, 88% and 89%, respectively. In hypertrophic cardiomyopathy, the presence of abnormal Q waves on the 12 lead ECG is primarily a function of the relation of right ventricular wall thickness and upper anterior septal thickness.
肥厚型心肌病中异常Q波的病因仍不清楚。对67例（平均年龄40岁）肥厚型心肌病患者的8个左心室和10个右心室部位进行二维超声心动图评估心肌壁厚度，并结合静息12导联心电图（ECG）上异常Q波的存在情况分析结果。67例患者中有19例（28%）出现异常Q波。无异常Q波的患者右心室肥厚明显更常见（48例中的25例[52%]对比19例中的2例[11%]，p<0.001）。单因素分析显示，有六项测量值与异常Q波显著相关：上前间隔厚度增加（p<0.005）和左心室最大壁厚度增加（p<0.02），平均和最大右心室壁厚度减小（均p<0.005），以及上前间隔与平均右心室壁厚度之比增加（p<0.005）和上前间隔与上后壁厚度之比增加（p<0.005）。多因素分析显示，只有上前间隔与平均右心室壁厚度之比（p<0.005）和与上后壁厚度之比（p<0.05）与异常Q波的存在显著相关，并分别以90%、88%和89%的敏感性、特异性和预测准确性预测Q波位置。在肥厚型心肌病中，12导联ECG上异常Q波的存在主要取决于右心室壁厚度与上前间隔厚度的关系。
