Cernohorský J
Vnitr Lek. 1989 Feb;35(2):184-90.
Voltage criteria of QRS are considered one of the signs of left ventricular hypertrophy. An increase of the R wave above the left precordium after a load is considered a manifestation of left ventricular ischaemia and evidence of coronary heart disease, but also a criterium of left ventricular function the volume of which increases as a result of altered haemodynamics. The voltage criteria of left ventricular hypertrophy are, however, of low sensitivity and specificity, as indicated by anatomical and echocardiographic investigations. The tracing of the electric field on the heart surface is not only influenced by the heart as a generator of electric energy but also by some other factors which are briefly discussed. Views on the change of voltage of the R wave after a load differ as regards its diagnostic impact, sensitivity and specificity for the diagnosis of coronary disease and the possibility to evaluate left ventricular function. From a review of the literature ensues that increase of the R wave after a load is due to a sufficient slower conduction in the ischaemic tissue but not as a result of enlargement of left ventricular volume which occurs as a result of altered haemodynamics induced by ischaemia.
QRS波电压标准被认为是左心室肥厚的体征之一。负荷后左胸前导联R波增高被认为是左心室缺血的表现及冠心病的证据，同时也是左心室功能的一项标准，其容量因血流动力学改变而增加。然而，解剖学和超声心动图研究表明，左心室肥厚的电压标准敏感性和特异性较低。心脏表面电场的描记不仅受作为电能发生器的心脏影响，还受一些其他因素影响，本文将简要讨论这些因素。关于负荷后R波电压变化，其对冠心病诊断的影响、敏感性和特异性以及评估左心室功能的可能性等方面的观点存在差异。从文献综述可知，负荷后R波增高是由于缺血组织中传导足够缓慢，而非缺血诱导的血流动力学改变导致左心室容量增大所致。
