Bacharova Ljuba, Ugander Martin
International Laser Center, Bratislava, Slovak Republic; Institute of Pathophysiology, Medical School, Comenius University, Bratislava, Slovak Republic.
Ann Noninvasive Electrocardiol. 2014 Nov;19(6):524-33. doi: 10.1111/anec.12223. Epub 2014 Nov 4.
Conventional assessment of left ventricular hypertrophy (LVH) using the electrocardiogram (ECG), for example, by the Sokolow-Lyon, Romhilt-Estes or Cornell criteria, have relied on assessing changes in the amplitude and/or duration of the QRS complex of the ECG to quantify LV mass. ECG measures of LV mass have typically been validated by imaging with echocardiography or cardiovascular magnetic resonance imaging (CMR). However, LVH can be the result of diverse etiologies, and LVH is also characterized by pathological changes in myocardial tissue characteristics on the genetic, molecular, cellular, and tissue level beyond a pure increase in the number of otherwise normal cardiomyocytes. For example, slowed conduction velocity through the myocardium, which can be due to diffuse myocardial fibrosis, has been shown to be an important determinant of conventional ECG LVH criteria regardless of LV mass. Myocardial tissue characterization by CMR has emerged to not only quantify LV mass, but also detect and quantify the extent and severity of focal or diffuse myocardial fibrosis, edema, inflammation, myocarditis, fatty replacement, myocardial disarray, and myocardial deposition of amyloid proteins (amyloidosis), glycolipids (Fabry disease), or iron (siderosis). This can be undertaken using CMR techniques including late gadolinium enhancement (LGE), T1 mapping, T2 mapping, T2* mapping, extracellular volume fraction (ECV) mapping, fat/water-weighted imaging, and diffusion tensor CMR. This review presents an overview of current and emerging concepts regarding the diagnostic possibilities of both ECG and CMR for LVH in an attempt to narrow gaps in our knowledge regarding the ECG diagnosis of LVH.
例如，使用心电图（ECG）通过索科洛 - 里昂、罗姆希尔特 - 埃斯泰斯或康奈尔标准对左心室肥厚（LVH）进行传统评估，一直依赖于评估心电图QRS波群的幅度和/或持续时间变化来量化左心室质量。左心室质量的心电图测量通常已通过超声心动图或心血管磁共振成像（CMR）成像进行验证。然而，LVH可能由多种病因引起，并且LVH的特征还在于心肌组织特征在基因、分子、细胞和组织水平上的病理变化，而不仅仅是正常心肌细胞数量的单纯增加。例如，已证明心肌传导速度减慢（可能由于弥漫性心肌纤维化）是传统心电图LVH标准的重要决定因素，无论左心室质量如何。CMR对心肌组织的表征不仅可以量化左心室质量，还可以检测和量化局灶性或弥漫性心肌纤维化、水肿、炎症、心肌炎、脂肪替代、心肌紊乱以及淀粉样蛋白（淀粉样变性）、糖脂（法布里病）或铁（含铁血黄素沉着症）在心肌中的沉积程度和严重程度。这可以使用CMR技术来进行，包括延迟钆增强（LGE）、T1映射、T2映射、T2 *映射、细胞外容积分数（ECV）映射、脂肪/水加权成像和扩散张量CMR。本综述概述了关于ECG和CMR对LVH诊断可能性的当前和新兴概念，试图缩小我们在LVH心电图诊断知识方面的差距。
