Bratincsák András, Williams Matthew, Kimata Chieko, Perry James C
Division of Cardiology, Kapiolani Medical Specialists, Hawaii Pacific Health, Honolulu, Hawaii, USA.
Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA.
Congenit Heart Dis. 2015 Jul-Aug;10(4):E164-71. doi: 10.1111/chd.12249. Epub 2015 Jan 20.
The electrocardiogram (ECG) is used to detect left ventricular hypertrophy (LVH) in children and young adults, and it is considered an important screening tool for the most common causes of sudden cardiac arrest in the United States. However, the reliability and accuracy of the ECG in the detection of LVH are poorly understood. This study's objective was to assess the reliability and accuracy of ECG parameters predicting LVH in comparison with echocardiographic two-dimensional left ventricular mass (2D-LVM) assessment.
Two hundred fifty patients met study criteria with complete 2D-LVM measurements, temporally matched ECGs and no confounding structural heart defects. The echocardiographic diagnosis of LVH was made by 2D-LVM z-score > 2. The electrocardiographic diagnosis of LVH was fulfilled if specific Q, R, or S wave voltages exceeded the normal limits for the respective age groups established by the Davignon, Macfarlane and Rijnbeek datasets, or fulfilled the LVH criteria set forth by adult indices (Sokolow-Lyon, Cornell, Gubner, Romhilt-Estes).
None of the ECG parameters showed significant correlation with 2D-LVM z-scores. In the detection of LVH, the most commonly used R in V6 voltages showed the following results: sensitivity 13-29%, specificity 77-96%, positive predictive value (PPV) 29-50%, and negative predictive value (NPV) 77%. The overall accuracy ranged 65-75%. The accuracy of adult indices for LVH ranged from 49% to 78%.
The ECG's prediction of LVH is unreliable with dismal sensitivity, variable specificity, poor PPV, and barely acceptable NPV. With such overall poor reliability, the use of current ECG standards in screening for LVH warrants reassessment.
心电图（ECG）用于检测儿童和青年的左心室肥厚（LVH），它被认为是美国心脏性猝死最常见病因的重要筛查工具。然而，人们对ECG检测LVH的可靠性和准确性了解甚少。本研究的目的是评估与超声心动图二维左心室质量（2D-LVM）评估相比，ECG参数预测LVH的可靠性和准确性。
250例患者符合研究标准，有完整的2D-LVM测量值、时间匹配的ECG且无混杂的结构性心脏缺陷。LVH的超声心动图诊断依据2D-LVM z评分>2做出。如果特定的Q、R或S波电压超过了Davignon、Macfarlane和Rijnbeek数据集为各年龄组确定的正常范围，或符合成人指标（Sokolow-Lyon、Cornell、Gubner、Romhilt-Estes）设定的LVH标准，则做出LVH的心电图诊断。
没有一个ECG参数与2D-LVM z评分显示出显著相关性。在LVH检测中，最常用的V6导联R波电压显示出以下结果：敏感性为13%-29%，特异性为77%-96%，阳性预测值（PPV）为29%-50%，阴性预测值（NPV）为77%。总体准确性在65%-75%之间。成人LVH指标的准确性在49%至78%之间。
ECG对LVH的预测不可靠，敏感性差，特异性可变，PPV低，NPV勉强可接受。鉴于总体可靠性如此之低，在LVH筛查中使用当前的ECG标准值得重新评估。
