心电图在左束支传导阻滞高血压患者左心室肥厚诊断中的表现

Electrocardiogram Performance in the Diagnosis of Left Ventricular Hypertrophy in Hypertensive Patients With Left Bundle Branch Block.

作者信息

Burgos Paula Freitas Martins, Luna Filho Bráulio, Costa Francisco de Assis, Bombig Maria Teresa Nogueira, Souza Dilma de, Bianco Henrique Tria, Oliveira Filho Japy Angelini, Izar Maria Cristina de Oliveira, Fonseca Francisco Antonio Helfenstein, Póvoa Rui

机构信息

Universidade Federal de São Paulo, Brazil.

Universidade Federal do Pará, Belém, PA, Brazil.

出版信息

Arq Bras Cardiol. 2017 Jan;108(1):47-52. doi: 10.5935/abc.20160187. Epub 2016 Dec 19.

DOI:10.5935/abc.20160187

PMID:27992034

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5245847/

Abstract

BACKGROUND

Left ventricular hypertrophy (LVH) is an important risk factor for cardiovascular events, and its detection usually begins with an electrocardiogram (ECG).

OBJECTIVE

To evaluate the impact of complete left bundle branch block (CLBBB) in hypertensive patients in the diagnostic performance of LVH by ECG.

METHODS

A total of 2,240 hypertensive patients were studied. All of them were submitted to an ECG and an echocardiogram (ECHO). We evaluated the most frequently used electrocardiographic criteria for LVH diagnosis: Cornell voltage, Cornell voltage product, Sokolow-Lyon voltage, Sokolow-Lyon product, RaVL, RaVL+SV3, RV6/RV5 ratio, strain pattern, left atrial enlargement, and QT interval. LVH identification pattern was the left ventricular mass index (LVMI) obtained by ECHO in all participants.

RESULTS

Mean age was 11.3 years ± 58.7 years, 684 (30.5%) were male and 1,556 (69.5%) were female. In patients without CLBBB, ECG sensitivity to the presence of LVH varied between 7.6 and 40.9%, and specificity varied between 70.2% and 99.2%. In participants with CLBBB, sensitivity to LVH varied between 11.9 and 95.2%, and specificity between 6.6 and 96.6%. Among the criteria with the best performance for LVH with CLBBB, Sokolow-Lyon, for a voltage of ≥ 3,0mV, stood out with a sensitivity of 22.2% (CI 95% 15.8 - 30.8) and specificity of 88.3% (CI 95% 77.8 - 94.2).

CONCLUSION

In hypertensive patients with CLBBB, the most often used criteria for the detection of LVH with ECG showed significant decrease in performance with regards to sensitivity and specificity. In this scenario, Sokolow-Lyon criteria with voltage ≥3,0mV presented the best performance.

摘要

背景

左心室肥厚（LVH）是心血管事件的重要危险因素，其检测通常始于心电图（ECG）。

目的

评估完全性左束支传导阻滞（CLBBB）对高血压患者心电图诊断LVH性能的影响。

方法

共研究了2240例高血压患者。所有患者均接受了心电图和超声心动图（ECHO）检查。我们评估了最常用的LVH诊断心电图标准：康奈尔电压、康奈尔电压乘积、索科洛夫-里昂电压、索科洛夫-里昂乘积、RaVL、RaVL+SV3、RV6/RV5比值、应变模式、左心房扩大和QT间期。LVH识别模式为所有参与者通过ECHO获得的左心室质量指数（LVMI）。

结果

平均年龄为11.3岁±58.7岁，男性684例（30.5%），女性1556例（69.5%）。在无CLBBB的患者中，心电图对LVH存在的敏感性在7.6%至40.9%之间，特异性在70.2%至99.2%之间。在有CLBBB的参与者中，对LVH的敏感性在11.9%至95.2%之间，特异性在6.6%至96.6%之间。在CLBBB患者中对LVH诊断性能最佳的标准中，索科洛夫-里昂标准（电压≥3.0mV）表现突出，敏感性为22.2%（95%CI 15.8 - 30.8），特异性为88.3%（95%CI 77.8 - 94.2）。