Department of Medicine, Division of Cardiology, University of California, San Francisco, California.
Department of Medicine, Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
J Am Coll Cardiol. 2014 Feb 25;63(7):672-681. doi: 10.1016/j.jacc.2013.08.1633. Epub 2013 Sep 28.
The study aimed to assess the diagnostic properties of electrocardiographic (ECG) criteria for right ventricular hypertrophy (RVH) measured by cardiac magnetic resonance imaging (cMRI) in adults without clinical cardiovascular disease.
Current ECG criteria for RVH were based on cadaveric dissection in small studies.
MESA (Multi-Ethnic Study of Atherosclerosis) performed cMRIs with complete right ventricle (RV) interpretation on 4,062 participants without clinical cardiovascular disease. Endocardial margins of the RV were manually contoured on diastolic and systolic images. The ECG screening criteria for RVH from the 2009 American Heart Association Recommendations for Standardization and Interpretation of the ECG were examined in participants with and without left ventricular (LV) hypertrophy or reduced ejection fraction. RVH was defined using sex-specific normative equations based on age, height, and weight.
The study sample with normal LV morphology and function (n = 3,719) was age 61.3 ± 10.0 years, 53.5% female, 39.6% Caucasian, 25.5% African American, 21.9% Hispanic, and 13.0% Asian. The mean body mass index was 27.9 ± 5.0 kg/m(2). A total of 6% had RVH, which was generally mild. Traditional ECG criteria were specific (many >95%) but had low sensitivity for RVH by cMRI. The positive predictive values were not sufficiently high as to be clinically useful (maximum 12%). The results did not differ based on age, sex, race, or smoking status, or with the inclusion of participants with abnormal LV mass or function. Classification and regression tree analysis revealed that no combination of ECG variables was better than the criteria used singly.
The recommended ECG screening criteria for RVH are not sufficiently sensitive or specific for screening for mild RVH in adults without clinical cardiovascular disease.
本研究旨在评估无临床心血管疾病的成年人中心脏磁共振成像（cMRI）测量的右心室肥厚（RVH）的心电图（ECG）标准的诊断性能。
目前的 RVH 心电图标准基于小样本的尸体解剖研究。
无临床心血管疾病的 4062 名参与者进行了 MESA（动脉粥样硬化的多民族研究）cMRI，对右心室（RV）进行了完整的解读。RV 的心内膜边缘在舒张期和收缩期图像上手动描绘。检查了 2009 年美国心脏协会推荐的 RVH 心电图筛查标准在伴有或不伴有左心室（LV）肥厚或射血分数降低的参与者中的应用。RVH 根据年龄、身高和体重的性别特异性正常范围方程定义。
具有正常 LV 形态和功能的研究样本（n=3719）年龄为 61.3±10.0 岁，女性占 53.5%，白种人占 39.6%，非裔美国人占 25.5%，西班牙裔占 21.9%，亚洲人占 13.0%。平均体重指数为 27.9±5.0kg/m2。共有 6%的人患有 RVH，通常程度较轻。传统的 ECG 标准特异性高（许多>95%），但 RVH 的 cMRI 敏感性低。阳性预测值不够高，没有临床应用价值（最高 12%）。结果不受年龄、性别、种族或吸烟状况的影响，也不受包括 LV 质量或功能异常的参与者的影响。分类和回归树分析显示，没有任何 ECG 变量组合比单独使用标准更好。
对于无临床心血管疾病的成年人，推荐的 RVH 心电图筛查标准的敏感性或特异性不足以筛查轻度 RVH。
